Provider Demographics
NPI:1871668475
Name:CHAN, YIMMING (LAC, DIPLAC)
Entity Type:Individual
Prefix:MS
First Name:YIMMING
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11095 LA PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4717
Mailing Address - Country:US
Mailing Address - Phone:408-930-6901
Mailing Address - Fax:
Practice Address - Street 1:1848 SARATOGA AVE
Practice Address - Street 2:BLDG 6-A
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6612
Practice Address - Country:US
Practice Address - Phone:408-930-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11188171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist