Provider Demographics
NPI:1124663448
Name:JI, STEVEN YONG (LAC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:YONG
Last Name:JI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:YONG
Other - Middle Name:SUK
Other - Last Name:JI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:18 TEXAS CT
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3123
Mailing Address - Country:US
Mailing Address - Phone:718-216-8688
Mailing Address - Fax:
Practice Address - Street 1:2488 GRAND CONCOURSE RM 206
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5207
Practice Address - Country:US
Practice Address - Phone:718-216-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist