Provider Demographics
NPI:1669012654
Name:YUAN, ZUOBIAO (LAC)
Entity Type:Individual
Prefix:
First Name:ZUOBIAO
Middle Name:
Last Name:YUAN
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 1:6075 MC KINLEY PL
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8110
Mailing Address - Country:US
Mailing Address - Phone:434-227-2863
Mailing Address - Fax:
Practice Address - Street 1:7550 FRANCE AVE S STE 220
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4762
Practice Address - Country:US
Practice Address - Phone:612-859-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1939171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist