Provider Demographics
NPI:1770021255
Name:YEUNG, KAN WA (LAC)
Entity Type:Individual
Prefix:
First Name:KAN WA
Middle Name:
Last Name:YEUNG
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 1:449 KINARD CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-5003
Mailing Address - Country:US
Mailing Address - Phone:917-886-6225
Mailing Address - Fax:917-591-1525
Practice Address - Street 1:6580 OLD MONROE RD STE A
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5362
Practice Address - Country:US
Practice Address - Phone:917-886-6225
Practice Address - Fax:917-591-1525
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005916-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist