Provider Demographics
NPI:1720515992
Name:YANG, KIA (DTCM, LAC, DIPLOM)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:DTCM, LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7342 ALCEDO CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2834
Mailing Address - Country:US
Mailing Address - Phone:916-266-3110
Mailing Address - Fax:
Practice Address - Street 1:7880 ALTA VALLEY DR STE 210
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4909
Practice Address - Country:US
Practice Address - Phone:916-426-6991
Practice Address - Fax:916-520-3774
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17620171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist