Provider Demographics
NPI:1346539400
Name:TAN, LUYANG (AC12693)
Entity Type:Individual
Prefix:
First Name:LUYANG
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:AC12693
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13256 POWAY RD STE B
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4609
Mailing Address - Country:US
Mailing Address - Phone:858-679-9368
Mailing Address - Fax:
Practice Address - Street 1:13256 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4609
Practice Address - Country:US
Practice Address - Phone:858-679-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12693171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist