Provider Demographics
NPI:1477094266
Name:YU DAYI CHINESE MEDICINE INC.
Entity Type:Organization
Organization Name:YU DAYI CHINESE MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHOUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:OMD, LAC
Authorized Official - Phone:805-523-9155
Mailing Address - Street 1:530 E LOS ANGELES AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2081
Mailing Address - Country:US
Mailing Address - Phone:805-523-9155
Mailing Address - Fax:
Practice Address - Street 1:530 E LOS ANGELES AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2081
Practice Address - Country:US
Practice Address - Phone:805-523-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty