Provider Demographics
NPI:1427198423
Name:YAN, TIMOTHY (LAC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:YAN
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 1:500 ALFRED NOBEL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1840
Mailing Address - Country:US
Mailing Address - Phone:510-724-8882
Mailing Address - Fax:510-779-5349
Practice Address - Street 1:500 ALFRED NOBEL DR STE 220
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1840
Practice Address - Country:US
Practice Address - Phone:510-724-8882
Practice Address - Fax:510-779-5349
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8043171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist