Provider Demographics
NPI:1548399678
Name:FANG, YUELI
Entity type:Individual
Prefix:
First Name:YUELI
Middle Name:
Last Name:FANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4715
Mailing Address - Country:US
Mailing Address - Phone:626-282-2712
Mailing Address - Fax:626-458-0570
Practice Address - Street 1:927 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4715
Practice Address - Country:US
Practice Address - Phone:626-278-9476
Practice Address - Fax:626-458-0570
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11489171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist