Provider Demographics
NPI:1093304776
Name:SYMONENKO, YANA (LAC)
Entity Type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:SYMONENKO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 CHALET DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5229
Mailing Address - Country:US
Mailing Address - Phone:848-333-2704
Mailing Address - Fax:
Practice Address - Street 1:3469 CHALET DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5229
Practice Address - Country:US
Practice Address - Phone:848-333-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12036026-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist