Provider Demographics
NPI:1518040021
Name:JI, YAN (LAC)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:JI
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 1:5300 DTC PKWY STE 330
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3159
Mailing Address - Country:US
Mailing Address - Phone:303-337-2866
Mailing Address - Fax:303-337-2866
Practice Address - Street 1:5300 DTC PKWY STE 330
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3159
Practice Address - Country:US
Practice Address - Phone:303-337-2866
Practice Address - Fax:303-337-2866
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1206171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist