Provider Demographics
NPI:1851053524
Name:YUAN WELLNESS CENTER
Entity Type:Organization
Organization Name:YUAN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:650-888-5288
Mailing Address - Street 1:20445 PACIFICA DR STE A1
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3017
Mailing Address - Country:US
Mailing Address - Phone:650-888-5288
Mailing Address - Fax:
Practice Address - Street 1:20445 PACIFICA DR STE A1
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3017
Practice Address - Country:US
Practice Address - Phone:650-888-5288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center