Provider Demographics
NPI:1720229271
Name:JYAN, RICHARD (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:JYAN
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 262ND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2514
Mailing Address - Country:US
Mailing Address - Phone:718-631-1468
Mailing Address - Fax:718-228-6592
Practice Address - Street 1:5819 262ND ST
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2514
Practice Address - Country:US
Practice Address - Phone:718-631-1468
Practice Address - Fax:718-228-6592
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003940171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist