Provider Demographics
NPI:1508127432
Name:YAN, DA (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:DA
Middle Name:
Last Name:YAN
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4897 BUFORD HWY STE 223
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3669
Mailing Address - Country:US
Mailing Address - Phone:404-789-5992
Mailing Address - Fax:
Practice Address - Street 1:4897 BUFORD HWY STE 223
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3669
Practice Address - Country:US
Practice Address - Phone:404-789-5992
Practice Address - Fax:678-224-5186
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000263171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist