Provider Demographics
NPI:1225840382
Name:SUH, YAE JI (LAC)
Entity type:Individual
Prefix:
First Name:YAE JI
Middle Name:
Last Name:SUH
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 1:3365 14TH ST APT 11A
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4651
Mailing Address - Country:US
Mailing Address - Phone:808-464-0640
Mailing Address - Fax:
Practice Address - Street 1:1831 STARR ST STE 6
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1132
Practice Address - Country:US
Practice Address - Phone:646-480-6584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007584171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist