Provider Demographics
NPI:1013080449
Name:FANG, JOHN (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:FANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:JIUUN YAU
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:10722 ARROW RTE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4808
Mailing Address - Country:US
Mailing Address - Phone:909-856-0670
Mailing Address - Fax:909-484-8198
Practice Address - Street 1:10722 ARROW RTE
Practice Address - Street 2:SUITE 510
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4808
Practice Address - Country:US
Practice Address - Phone:909-856-0670
Practice Address - Fax:909-484-8198
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6976171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist