Provider Demographics
NPI:1760633143
Name:YUANN, MARIE KRISTINE (LAC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:KRISTINE
Last Name:YUANN
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 1:2901 OCEAN PARK BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2964
Mailing Address - Country:US
Mailing Address - Phone:310-968-8198
Mailing Address - Fax:
Practice Address - Street 1:2901 OCEAN PARK BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2964
Practice Address - Country:US
Practice Address - Phone:310-968-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12580171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist