Provider Demographics
NPI:1679016117
Name:YI, JANE (RD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-4035
Mailing Address - Country:US
Mailing Address - Phone:848-666-7098
Mailing Address - Fax:848-666-7176
Practice Address - Street 1:1521 IRVING ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-4035
Practice Address - Country:US
Practice Address - Phone:848-666-7098
Practice Address - Fax:848-666-7176
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1046719133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered