Provider Demographics
NPI:1891840187
Name:YANG, CHEN-HAO (LAC)
Entity Type:Individual
Prefix:
First Name:CHEN-HAO
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S HACIENDA BLVD
Mailing Address - Street 2:#D
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4265
Mailing Address - Country:US
Mailing Address - Phone:626-855-1158
Mailing Address - Fax:626-369-9654
Practice Address - Street 1:2020 S HACIENDA BLVD
Practice Address - Street 2:#D
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4265
Practice Address - Country:US
Practice Address - Phone:626-855-1158
Practice Address - Fax:626-369-9654
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6617171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0066170Medicaid