Provider Demographics
NPI:1558519033
Name:YU, DEOK SANG (DAC, LAC)
Entity Type:Individual
Prefix:DR
First Name:DEOK SANG
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:DAC, LAC
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAC, LAC
Mailing Address - Street 1:1100 W SHAW AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3708
Mailing Address - Country:US
Mailing Address - Phone:559-444-3269
Mailing Address - Fax:559-229-2939
Practice Address - Street 1:1100 W SHAW AVE STE 118
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3708
Practice Address - Country:US
Practice Address - Phone:559-444-3269
Practice Address - Fax:559-229-2939
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12562171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12562OtherACUPUNCTURE BOARD