Provider Demographics
NPI:1962567701
Name:HWANG, YEANHA TERESA (OMD,LAC)
Entity type:Individual
Prefix:
First Name:YEANHA
Middle Name:TERESA
Last Name:HWANG
Suffix:
Gender:F
Credentials:OMD,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 S WALNUT ST
Mailing Address - Street 2:#2003
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2270
Mailing Address - Country:US
Mailing Address - Phone:714-563-0303
Mailing Address - Fax:
Practice Address - Street 1:520 N MAIN ST
Practice Address - Street 2:#240
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4623
Practice Address - Country:US
Practice Address - Phone:714-285-0240
Practice Address - Fax:714-285-0333
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9927171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC9927OtherACUPUNCTURE BOARD LICENCE