Provider Demographics
NPI:1386819944
Name:FANG, YUANLI (ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:YUANLI
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3596
Mailing Address - Country:US
Mailing Address - Phone:626-823-8208
Mailing Address - Fax:626-307-8705
Practice Address - Street 1:222 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3596
Practice Address - Country:US
Practice Address - Phone:626-823-8208
Practice Address - Fax:626-307-8705
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12442171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist