Provider Demographics
NPI:1558561258
Name:SONG, YAO CHENG
Entity Type:Individual
Prefix:
First Name:YAO CHENG
Middle Name:
Last Name:SONG
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 1:10090 PASADENA AVE., STE A2
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5939
Mailing Address - Country:US
Mailing Address - Phone:408-253-9829
Mailing Address - Fax:408-253-0131
Practice Address - Street 1:10090 PASADENA AVE STE A2
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5939
Practice Address - Country:US
Practice Address - Phone:408-253-9829
Practice Address - Fax:408-253-0131
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist