Provider Demographics
NPI:1962606947
Name:YI, JANG YOL (LAC)
Entity type:Individual
Prefix:
First Name:JANG YOL
Middle Name:
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 1:3301 169TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1809
Mailing Address - Country:US
Mailing Address - Phone:718-961-2255
Mailing Address - Fax:718-961-7939
Practice Address - Street 1:3301 169TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1809
Practice Address - Country:US
Practice Address - Phone:718-961-2255
Practice Address - Fax:718-961-7939
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000448171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist