Provider Demographics
NPI:1326767328
Name:KANG, YUJIN KARA (LAC)
Entity Type:Individual
Prefix:
First Name:YUJIN
Middle Name:KARA
Last Name:KANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LAKE COOK RD STE 121
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4914
Mailing Address - Country:US
Mailing Address - Phone:630-732-1529
Mailing Address - Fax:
Practice Address - Street 1:420 LAKE COOK RD STE 121
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4914
Practice Address - Country:US
Practice Address - Phone:630-732-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001588171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198.001588OtherACUPUNCTURE