Provider Demographics
NPI:1245310929
Name:FANG, YUEMIAO (LAC)
Entity type:Individual
Prefix:
First Name:YUEMIAO
Middle Name:
Last Name:FANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 INDUSTRIAL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4118
Mailing Address - Country:US
Mailing Address - Phone:650-637-1680
Mailing Address - Fax:
Practice Address - Street 1:1091 INDUSTRIAL RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4118
Practice Address - Country:US
Practice Address - Phone:650-637-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5943171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0059430Medicaid