Provider Demographics
NPI:1447666185
Name:YANG, LEI (MM)
Entity type:Individual
Prefix:
First Name:LEI
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:MM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11804 VALLEY BLVD.
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3044
Mailing Address - Country:US
Mailing Address - Phone:626-454-3789
Mailing Address - Fax:
Practice Address - Street 1:11804 VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3044
Practice Address - Country:US
Practice Address - Phone:626-454-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14260171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA465378353Medicare PIN