Provider Demographics
NPI:1649419797
Name:YUAN, RUNKEL R K (LAC)
Entity Type:Individual
Prefix:
First Name:RUNKEL
Middle Name:R K
Last Name:YUAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1944
Mailing Address - Country:US
Mailing Address - Phone:516-766-0897
Mailing Address - Fax:516-766-0318
Practice Address - Street 1:2954 CLARK AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1944
Practice Address - Country:US
Practice Address - Phone:516-766-0897
Practice Address - Fax:516-766-0318
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00003518171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist