Provider Demographics
NPI:1326502899
Name:YI, MACKENZIE (DO)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 TAYLOR ST STE 6J
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2930
Mailing Address - Country:US
Mailing Address - Phone:803-434-1433
Mailing Address - Fax:
Practice Address - Street 1:1301 TAYLOR ST STE 6J
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2930
Practice Address - Country:US
Practice Address - Phone:803-434-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL925152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry