Provider Demographics
NPI:1215349600
Name:YU, MYUNG (LAC)
Entity type:Individual
Prefix:
First Name:MYUNG
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1924
Mailing Address - Country:US
Mailing Address - Phone:201-233-5742
Mailing Address - Fax:
Practice Address - Street 1:122 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1924
Practice Address - Country:US
Practice Address - Phone:201-233-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004714171100000X
NJ25MZ00107100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist