Provider Demographics
NPI:1417155755
Name:YEH, MAO-JUNG
Entity Type:Individual
Prefix:MR
First Name:MAO-JUNG
Middle Name:
Last Name:YEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 ZION LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2361
Mailing Address - Country:US
Mailing Address - Phone:408-661-2620
Mailing Address - Fax:
Practice Address - Street 1:3057 ZION LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2361
Practice Address - Country:US
Practice Address - Phone:408-661-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6494171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC6494OtherACUPUNCTURE