Provider Demographics
NPI:1164787842
Name:YI, KENNETH HYUN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HYUN
Last Name:YI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LEMON GRV
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4513
Mailing Address - Country:US
Mailing Address - Phone:206-390-2816
Mailing Address - Fax:
Practice Address - Street 1:122 LEMON GRV
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4513
Practice Address - Country:US
Practice Address - Phone:206-390-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist