Provider Demographics
NPI:1114266822
Name:YI, WHASOOK MARIA (DEPL AC & DEPLCH)
Entity Type:Individual
Prefix:MRS
First Name:WHASOOK
Middle Name:MARIA
Last Name:YI
Suffix:
Gender:F
Credentials:DEPL AC & DEPLCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:917-496-1232
Mailing Address - Fax:973-696-4878
Practice Address - Street 1:33 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:917-496-1232
Practice Address - Fax:973-696-4878
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00042800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist