Provider Demographics
NPI:1386710887
Name:HAN, YANQING (LAC)
Entity type:Individual
Prefix:PROF
First Name:YANQING
Middle Name:
Last Name:HAN
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 1:1220 S DIAMOND BAR BLVD # F
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4120
Mailing Address - Country:US
Mailing Address - Phone:909-396-8700
Mailing Address - Fax:
Practice Address - Street 1:1220 S DIAMOND BAR BLVD # F
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4120
Practice Address - Country:US
Practice Address - Phone:909-396-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7911171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0079110Medicaid