Provider Demographics
NPI:1821512864
Name:YANG, ALICIA (MA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-035 KONOHIKI ST APT 3843
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-6116
Mailing Address - Country:US
Mailing Address - Phone:808-352-7743
Mailing Address - Fax:808-352-7743
Practice Address - Street 1:270 KUULEI RD STE 205
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2755
Practice Address - Country:US
Practice Address - Phone:808-263-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1142171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist