Provider Demographics
NPI:1457793317
Name:YOUNG, TIAN K (LAC)
Entity Type:Individual
Prefix:
First Name:TIAN
Middle Name:K
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1649
Mailing Address - Country:US
Mailing Address - Phone:415-828-0063
Mailing Address - Fax:
Practice Address - Street 1:145 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-1649
Practice Address - Country:US
Practice Address - Phone:415-828-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15259171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist