Provider Demographics
NPI:1871953547
Name:CHANDRANATA, YULIANI (LAC, MSAOM, EAMP, ND)
Entity type:Individual
Prefix:
First Name:YULIANI
Middle Name:
Last Name:CHANDRANATA
Suffix:
Gender:F
Credentials:LAC, MSAOM, EAMP, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D' NATURAL SURABAYA
Mailing Address - Street 2:JL. DR. SOETOMO NO. 75
Mailing Address - City:SURABAYA
Mailing Address - State:JAWA TIMUR (EAST JAVA)
Mailing Address - Zip Code:60264
Mailing Address - Country:ID
Mailing Address - Phone:1909-859-9952
Mailing Address - Fax:
Practice Address - Street 1:4301 STONE WAY N, SUITE 211
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:909-859-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60623797171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist