Basic Information
Provider Information
NPI: 1659721876
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YAM
FirstName: HO MAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: L.AC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1520 STOCKTON ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941333354
CountryCode: US
TelephoneNumber: 4153919686
FaxNumber:  
Practice Location
Address1: 1520 STOCKTON ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 94133
CountryCode: US
TelephoneNumber: 4153919686
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2016
LastUpdateDate: 06/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000XAC16971CAY Other Service ProvidersAcupuncturist 

No ID Information.


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