Provider Demographics
NPI:1437175866
Name:CHRIS YI CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHRIS YI CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:SUNSHINE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:CHU SUNG
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-357-6800
Mailing Address - Street 1:433 ESTUDILLO AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4915
Mailing Address - Country:US
Mailing Address - Phone:510-357-6800
Mailing Address - Fax:510-357-6801
Practice Address - Street 1:433 ESTUDILLO AVE
Practice Address - Street 2:STE 208
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4915
Practice Address - Country:US
Practice Address - Phone:510-357-6800
Practice Address - Fax:510-357-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01991ZMedicare ID - Type Unspecified
CAY53498Medicare UPIN