Provider Demographics
NPI:1194411736
Name:YAN, TAO
Entity type:Individual
Prefix:
First Name:TAO
Middle Name:
Last Name:YAN
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 1:34667 MOONEY CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3219
Mailing Address - Country:US
Mailing Address - Phone:650-575-8492
Mailing Address - Fax:
Practice Address - Street 1:107 DIXON RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-2501
Practice Address - Country:US
Practice Address - Phone:650-575-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19717171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist