Provider Demographics
NPI:1205950516
Name:YAN, ALICE K (LAC)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:K
Last Name:YAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST
Mailing Address - Street 2:315
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4552
Mailing Address - Country:US
Mailing Address - Phone:212-226-8179
Mailing Address - Fax:212-274-1688
Practice Address - Street 1:139 CENTRE STREET
Practice Address - Street 2:315
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4165
Practice Address - Country:US
Practice Address - Phone:212-226-8179
Practice Address - Fax:212-274-1688
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001060171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist