Basic Information
Provider Information
NPI: 1093802050
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YANG
FirstName: LIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: O.M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1607 LAFAYETTE ST
Address2:  
City: SANTA CLARA
State: CA
PostalCode: 950503983
CountryCode: US
TelephoneNumber: 4082611777
FaxNumber: 4082611111
Practice Location
Address1: 1607 LAFAYETTE ST
Address2:  
City: SANTA CLARA
State: CA
PostalCode: 950503983
CountryCode: US
TelephoneNumber: 4082611777
FaxNumber: 4082611111
Other Information
ProviderEnumerationDate: 10/09/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000XAC6620CAY Other Service ProvidersAcupuncturist 

No ID Information.


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