Provider Demographics
NPI:1982268702
Name:YANG, AMY PING (LAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:PING
Last Name:YANG
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 1:2243 BENTLEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2424
Mailing Address - Country:US
Mailing Address - Phone:408-858-3836
Mailing Address - Fax:
Practice Address - Street 1:1630 OAKLAND RD STE A118
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2461
Practice Address - Country:US
Practice Address - Phone:408-858-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18502171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty