Provider Demographics
NPI:1699452920
Name:SITU, YIJING
Entity type:Individual
Prefix:
First Name:YIJING
Middle Name:
Last Name:SITU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 PICCADILLY PL APT 16
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2028
Mailing Address - Country:US
Mailing Address - Phone:415-246-3187
Mailing Address - Fax:
Practice Address - Street 1:413 PICCADILLY PL APT 16
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2028
Practice Address - Country:US
Practice Address - Phone:415-246-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40550225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist