Provider Demographics
NPI:1538498175
Name:YI, KIYEON
Entity Type:Individual
Prefix:
First Name:KIYEON
Middle Name:
Last Name:YI
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 1:2878 TREEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3142
Mailing Address - Country:US
Mailing Address - Phone:714-577-0995
Mailing Address - Fax:
Practice Address - Street 1:8251 WESTMINSTER BLVD
Practice Address - Street 2:STE 110
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3370
Practice Address - Country:US
Practice Address - Phone:714-577-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health