Provider Demographics
NPI:1174672703
Name:GREENBERG, FANG YU (LAC)
Entity Type:Individual
Prefix:MS
First Name:FANG
Middle Name:YU
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:FANG
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:311 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3714
Mailing Address - Country:US
Mailing Address - Phone:650-588-5685
Mailing Address - Fax:650-588-5690
Practice Address - Street 1:311 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3714
Practice Address - Country:US
Practice Address - Phone:650-588-5685
Practice Address - Fax:650-588-5690
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC 6319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist