Provider Demographics
NPI:1588069488
Name:YEE LOONG, STEPHANIE RAINE (LAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAINE
Last Name:YEE LOONG
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 1:6043 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4543
Mailing Address - Country:US
Mailing Address - Phone:720-233-7741
Mailing Address - Fax:
Practice Address - Street 1:6141 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1008
Practice Address - Country:US
Practice Address - Phone:720-233-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005458-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist