Provider Demographics
NPI:1225369788
Name:YANG, SUNNY YUANWAN (LAC)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:YUANWAN
Last Name:YANG
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 1:22706 ASPAN ST
Mailing Address - Street 2:#504
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1603
Mailing Address - Country:US
Mailing Address - Phone:949-454-2820
Mailing Address - Fax:949-415-2214
Practice Address - Street 1:22706 ASPAN ST
Practice Address - Street 2:#504
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1603
Practice Address - Country:US
Practice Address - Phone:949-454-2820
Practice Address - Fax:949-415-2214
Is Sole Proprietor?:No
Enumeration Date:2010-01-23
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13399171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist