Provider Demographics
NPI:1679594253
Name:YI, CHRIS CHU SUNG (DC)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:CHU SUNG
Last Name:YI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 ESTUDILLO AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4915
Mailing Address - Country:US
Mailing Address - Phone:510-357-6800
Mailing Address - Fax:510-357-6801
Practice Address - Street 1:433 ESTUDILLO AVE
Practice Address - Street 2:STE 208
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4915
Practice Address - Country:US
Practice Address - Phone:510-357-6800
Practice Address - Fax:510-357-6801
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5220434Medicaid
CA5220434Medicaid
CAU84515Medicare UPIN