Provider Demographics
NPI:1154049948
Name:BEAUTIFUL LIFE WELLNESS
Entity type:Organization
Organization Name:BEAUTIFUL LIFE WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-651-3668
Mailing Address - Street 1:1860 EL CAMINO REAL STE 50
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3100
Mailing Address - Country:US
Mailing Address - Phone:650-651-3668
Mailing Address - Fax:650-948-4993
Practice Address - Street 1:1860 EL CAMINO REAL STE 50
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3100
Practice Address - Country:US
Practice Address - Phone:650-651-3668
Practice Address - Fax:650-948-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2023-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty