Provider Demographics
NPI:1760533285
Name:YANG, ELAINE MANLI (OMD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MANLI
Last Name:YANG
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OMD
Mailing Address - Street 1:6625 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3822
Mailing Address - Country:US
Mailing Address - Phone:408-253-1688
Mailing Address - Fax:408-253-3333
Practice Address - Street 1:1084 S DE ANZA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3555
Practice Address - Country:US
Practice Address - Phone:408-255-1119
Practice Address - Fax:408-253-3333
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5970171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist