Provider Demographics
NPI:1104394600
Name:TIMOTHY YAN, A PROFESSIONAL ACUPUNCTURE ORGANIZATION
Entity type:Organization
Organization Name:TIMOTHY YAN, A PROFESSIONAL ACUPUNCTURE ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:510-724-8882
Mailing Address - Street 1:500 ALFRED NOBEL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1840
Mailing Address - Country:US
Mailing Address - Phone:510-724-8882
Mailing Address - Fax:
Practice Address - Street 1:500 ALFRED NOBEL DR STE 220
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1840
Practice Address - Country:US
Practice Address - Phone:510-724-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty