Provider Demographics
NPI:1558306258
Name:OU, YI (DC)
Entity type:Individual
Prefix:
First Name:YI
Middle Name:
Last Name:OU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 9TH ST
Mailing Address - Street 2:#304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4428
Mailing Address - Country:US
Mailing Address - Phone:415-215-7228
Mailing Address - Fax:510-452-0130
Practice Address - Street 1:212 9TH ST
Practice Address - Street 2:#304
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4428
Practice Address - Country:US
Practice Address - Phone:415-215-7228
Practice Address - Fax:510-452-0130
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88969Medicare UPIN
CADC0280130Medicare ID - Type Unspecified