Provider Demographics
NPI:1114131018
Name:MAEDO, ANNE YOUNGRAN (DC)
Entity Type:Individual
Prefix:PROF
First Name:ANNE
Middle Name:YOUNGRAN
Last Name:MAEDO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:RAN
Other - Last Name:WOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7212 ORANGETHORPE AVE STE 3B
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4660
Mailing Address - Country:US
Mailing Address - Phone:714-539-3793
Mailing Address - Fax:714-539-3952
Practice Address - Street 1:7212 ORANGETHORPE AVE STE 3B
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4660
Practice Address - Country:US
Practice Address - Phone:714-539-3793
Practice Address - Fax:714-539-3952
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU42190Medicare UPIN