Provider Demographics
NPI:1427418896
Name:YI-OK, KYEONGMI
Entity Type:Individual
Prefix:
First Name:KYEONGMI
Middle Name:
Last Name:YI-OK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 CONEY ISLAND AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5021
Mailing Address - Country:US
Mailing Address - Phone:718-382-1724
Mailing Address - Fax:
Practice Address - Street 1:2483 CONEY ISLAND AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5021
Practice Address - Country:US
Practice Address - Phone:718-382-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004979171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist