Provider Demographics
NPI:1629755202
Name:YI, SUNG (DPT)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S COLORADO BLVD STE 640
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1239
Mailing Address - Country:US
Mailing Address - Phone:303-320-4450
Mailing Address - Fax:
Practice Address - Street 1:400 S COLORADO BLVD STE 640
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1239
Practice Address - Country:US
Practice Address - Phone:303-320-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019124261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy