Provider Demographics
NPI:1477193290
Name:YANG, DAEJIN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:DAEJIN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LANE AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5207
Mailing Address - Country:US
Mailing Address - Phone:516-943-6784
Mailing Address - Fax:
Practice Address - Street 1:20 LANE AVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5207
Practice Address - Country:US
Practice Address - Phone:516-943-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006664171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist