Provider Demographics
NPI:1578880860
Name:YU, HAERANG GRACE
Entity Type:Individual
Prefix:MS
First Name:HAERANG
Middle Name:GRACE
Last Name:YU
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 1:22525 SE 64TH PL STE 110
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5386
Mailing Address - Country:US
Mailing Address - Phone:425-369-1040
Mailing Address - Fax:
Practice Address - Street 1:22525 SE 64TH PL STE 110
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5386
Practice Address - Country:US
Practice Address - Phone:425-369-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60147379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor