Provider Demographics
NPI:1053021345
Name:HUA, YVONNE YEN KIM (DC)
Entity type:Individual
Prefix:
First Name:YVONNE YEN
Middle Name:KIM
Last Name:HUA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 CHARNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1713
Mailing Address - Country:US
Mailing Address - Phone:408-315-3710
Mailing Address - Fax:
Practice Address - Street 1:3602 INLAND EMPIRE BLVD STE B120
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4997
Practice Address - Country:US
Practice Address - Phone:909-265-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36361OtherDC