Provider Demographics
NPI:1295024974
Name:YANG, SHAWN H (LAC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:H
Last Name:YANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25238 TANDEM WAY
Mailing Address - Street 2:#207A
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6903
Mailing Address - Country:US
Mailing Address - Phone:310-387-5803
Mailing Address - Fax:
Practice Address - Street 1:2727 W OLYMPIC BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2640
Practice Address - Country:US
Practice Address - Phone:213-384-1100
Practice Address - Fax:213-384-1101
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC14130OtherCA ACUPUNCTURE BOARD