Provider Demographics
NPI:1235610320
Name:YAN, MINGLU (LAC)
Entity type:Individual
Prefix:DR
First Name:MINGLU
Middle Name:
Last Name:YAN
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 1:28 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1105
Mailing Address - Country:US
Mailing Address - Phone:917-238-0905
Mailing Address - Fax:
Practice Address - Street 1:165 N VILLAGE AVE STE 128
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3763
Practice Address - Country:US
Practice Address - Phone:917-238-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001267171100000X
NY006114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist