Provider Demographics
NPI:1588326797
Name:YI, JENNIFER YOUNGSHIN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:YOUNGSHIN
Last Name:YI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 HAMMOND BUSINESS PL STE 105
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3666
Mailing Address - Country:US
Mailing Address - Phone:609-477-4433
Mailing Address - Fax:
Practice Address - Street 1:3040 HAMMOND BUSINESS PL STE 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3666
Practice Address - Country:US
Practice Address - Phone:919-899-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical