Provider Demographics
NPI:1972168441
Name:YUAN, JINGYUN
Entity Type:Individual
Prefix:
First Name:JINGYUN
Middle Name:
Last Name:YUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RIVER OAKS PKWY UNIT 1115
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-3568
Mailing Address - Country:US
Mailing Address - Phone:510-458-6759
Mailing Address - Fax:
Practice Address - Street 1:10430 S DE ANZA BLVD # 230A
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3019
Practice Address - Country:US
Practice Address - Phone:669-230-6822
Practice Address - Fax:669-230-6823
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist