Provider Demographics
NPI:1720273774
Name:YI, YONG HWAN (LAC)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:HWAN
Last Name:YI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LIONS RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1310
Mailing Address - Country:US
Mailing Address - Phone:610-202-1244
Mailing Address - Fax:
Practice Address - Street 1:211 W LANCASTER AVE
Practice Address - Street 2:2ND FL.
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1730
Practice Address - Country:US
Practice Address - Phone:610-647-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000862171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist