Provider Demographics
NPI:1891298691
Name:LUO, YIFAN (LAC, MSTCM)
Entity type:Individual
Prefix:
First Name:YIFAN
Middle Name:
Last Name:LUO
Suffix:
Gender:M
Credentials:LAC, MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 N KAREN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-0433
Mailing Address - Country:US
Mailing Address - Phone:559-392-2198
Mailing Address - Fax:
Practice Address - Street 1:1551 E SHAW AVE STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8007
Practice Address - Country:US
Practice Address - Phone:559-392-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17613171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC17613OtherCALIFORNIA ACUPUNCTURE BOARD LICENSE