Provider Demographics
NPI:1710374319
Name:YI, MYOUNG HEE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MYOUNG
Middle Name:HEE
Last Name:YI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S. ANITA DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:626-688-8421
Mailing Address - Fax:
Practice Address - Street 1:201 S. ANITA DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:626-688-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16259171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist