Provider Demographics
NPI:1790805745
Name:BAO, XIANG YANG (LAC)
Entity Type:Individual
Prefix:
First Name:XIANG YANG
Middle Name:
Last Name:BAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15333 CULVER DR STE 800
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7129
Mailing Address - Country:US
Mailing Address - Phone:949-786-6118
Mailing Address - Fax:949-786-6118
Practice Address - Street 1:15333 CULVER DR STE 800
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7129
Practice Address - Country:US
Practice Address - Phone:949-786-6118
Practice Address - Fax:949-786-6118
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist