Provider Demographics
NPI:1407180730
Name:YUEN, WALLACE WEN YAN (LAC)
Entity Type:Individual
Prefix:
First Name:WALLACE
Middle Name:WEN YAN
Last Name:YUEN
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 1:2575 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2802
Mailing Address - Country:US
Mailing Address - Phone:415-806-6682
Mailing Address - Fax:
Practice Address - Street 1:2575 34TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2802
Practice Address - Country:US
Practice Address - Phone:415-806-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13327171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist