Provider Demographics
NPI:1760539894
Name:YU, YEON TAEK (LAC)
Entity Type:Individual
Prefix:MR
First Name:YEON TAEK
Middle Name:
Last Name:YU
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 1:3900 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2206
Mailing Address - Country:US
Mailing Address - Phone:949-756-2277
Mailing Address - Fax:949-756-2146
Practice Address - Street 1:3900 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2206
Practice Address - Country:US
Practice Address - Phone:949-756-2277
Practice Address - Fax:949-756-2146
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8428171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist