Provider Demographics
NPI:1912054818
Name:YUAN, CHUNGTSZ VIVIAN (LAC)
Entity Type:Individual
Prefix:
First Name:CHUNGTSZ
Middle Name:VIVIAN
Last Name:YUAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:YUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:759 PEEKSKILL DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1814
Mailing Address - Country:US
Mailing Address - Phone:408-739-4572
Mailing Address - Fax:
Practice Address - Street 1:759 PEEKSKILL DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1814
Practice Address - Country:US
Practice Address - Phone:408-739-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8005171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist