Provider Demographics
NPI:1366958548
Name:TU, YENJONG
Entity type:Individual
Prefix:
First Name:YENJONG
Middle Name:
Last Name:TU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YEN
Other - Middle Name:JONG
Other - Last Name:TU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9312
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95157-0312
Mailing Address - Country:US
Mailing Address - Phone:669-269-5080
Mailing Address - Fax:
Practice Address - Street 1:100 OCONNOR DR STE 27
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1655
Practice Address - Country:US
Practice Address - Phone:669-269-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-24
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17815171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist