Provider Demographics
NPI:1972015451
Name:DEYOUNG, ALICE LUCILLE (LAC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:LUCILLE
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:LUCILLE
Other - Last Name:DE YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:519 DOLORES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1564
Mailing Address - Country:US
Mailing Address - Phone:415-695-4094
Mailing Address - Fax:
Practice Address - Street 1:519 DOLORES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1564
Practice Address - Country:US
Practice Address - Phone:415-695-4094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17824171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist