Provider Demographics
NPI:1891824546
Name:YAN, JULIE CHAN (CA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CHAN
Last Name:YAN
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 N SPRING ST #208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2835
Mailing Address - Country:US
Mailing Address - Phone:213-625-1523
Mailing Address - Fax:
Practice Address - Street 1:668 N SPRING ST #208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2835
Practice Address - Country:US
Practice Address - Phone:213-625-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0024140Medicare ID - Type Unspecified04012001