Provider Demographics
NPI:1770016438
Name:YANG, JUNG LIEN
Entity Type:Individual
Prefix:MS
First Name:JUNG LIEN
Middle Name:
Last Name:YANG
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 1:13788 ROSWELL AVE
Mailing Address - Street 2:#138
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1409
Mailing Address - Country:US
Mailing Address - Phone:626-780-5698
Mailing Address - Fax:
Practice Address - Street 1:13788 ROSWELL AVE
Practice Address - Street 2:#138
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1409
Practice Address - Country:US
Practice Address - Phone:626-780-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist