Provider Demographics
NPI:1285937789
Name:YANG, DOO H (LAC)
Entity type:Individual
Prefix:
First Name:DOO
Middle Name:H
Last Name:YANG
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 1:9 TAPPAN PLZ
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-2814
Mailing Address - Country:US
Mailing Address - Phone:845-359-0953
Mailing Address - Fax:845-359-0953
Practice Address - Street 1:9 TAPPAN PLZ
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2814
Practice Address - Country:US
Practice Address - Phone:845-359-0953
Practice Address - Fax:845-359-0953
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004504-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist