Provider Demographics
NPI:1669687950
Name:YANG, TINA SHU-YA (MS, LAC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:SHU-YA
Last Name:YANG
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 BEAR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2964
Mailing Address - Country:US
Mailing Address - Phone:714-429-0838
Mailing Address - Fax:714-437-9631
Practice Address - Street 1:3140 BEAR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2964
Practice Address - Country:US
Practice Address - Phone:714-429-0838
Practice Address - Fax:714-437-9631
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist