Provider Demographics
NPI:1770864472
Name:YU, JAEHYUN (LAC)
Entity Type:Individual
Prefix:
First Name:JAEHYUN
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 1:14351 ROOSEVELT AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6126
Mailing Address - Country:US
Mailing Address - Phone:718-661-4130
Mailing Address - Fax:718-661-4132
Practice Address - Street 1:14351 ROOSEVELT AVE APT 1E
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6126
Practice Address - Country:US
Practice Address - Phone:718-661-4130
Practice Address - Fax:718-661-4132
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3780171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist