Provider Demographics
NPI:1922157395
Name:YANG, JIA (L AC)
Entity Type:Individual
Prefix:
First Name:JIA
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 BLACK AVE STE I
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6139
Mailing Address - Country:US
Mailing Address - Phone:925-339-1548
Mailing Address - Fax:
Practice Address - Street 1:4460 BLACK AVE STE I
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6139
Practice Address - Country:US
Practice Address - Phone:925-339-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7920171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist