Provider Demographics
NPI:1063987055
Name:YIN, JIE (LAC)
Entity type:Individual
Prefix:
First Name:JIE
Middle Name:
Last Name:YIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4063 FALLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4816
Mailing Address - Country:US
Mailing Address - Phone:781-389-5194
Mailing Address - Fax:
Practice Address - Street 1:4063 FALLWOOD CT
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4816
Practice Address - Country:US
Practice Address - Phone:781-389-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist