Provider Demographics
NPI:1104096890
Name:YI, JESHIK (LAC)
Entity type:Individual
Prefix:DR
First Name:JESHIK
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7275 BOULDER AVE # 3B
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-3385
Mailing Address - Country:US
Mailing Address - Phone:909-863-7597
Mailing Address - Fax:909-863-7597
Practice Address - Street 1:7275 BOULDER AVE.
Practice Address - Street 2:#3B
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346
Practice Address - Country:US
Practice Address - Phone:909-863-7597
Practice Address - Fax:909-863-7597
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist