Provider Demographics
NPI:1699454884
Name:YI, JASON (DIPL AC, LAC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:YI
Suffix:
Gender:
Credentials:DIPL AC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 WESTWOOD DR APT 162
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1626
Mailing Address - Country:US
Mailing Address - Phone:718-200-9092
Mailing Address - Fax:
Practice Address - Street 1:335 OXFORD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1970
Practice Address - Country:US
Practice Address - Phone:330-556-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000445171100000X
MDU03081171100000X
NY007370171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist