Provider Demographics
NPI:1679656474
Name:YANO, JEAN E (LAC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:YANO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W BADILLO ST STE E
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1923
Mailing Address - Country:US
Mailing Address - Phone:626-967-6461
Mailing Address - Fax:626-332-4264
Practice Address - Street 1:245 W BADILLO ST STE E
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1923
Practice Address - Country:US
Practice Address - Phone:626-967-6461
Practice Address - Fax:626-332-4264
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4222171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4628235Medicare UPIN