Provider Demographics
NPI:1760828255
Name:FAN, YANHUA
Entity Type:Individual
Prefix:MS
First Name:YANHUA
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 AMADOR RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1201
Mailing Address - Country:US
Mailing Address - Phone:510-512-4966
Mailing Address - Fax:
Practice Address - Street 1:4101 PERALTA BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4851
Practice Address - Country:US
Practice Address - Phone:510-818-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28295225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225700000XOtherMASSAGE THERPIST