Provider Demographics
NPI:1922208842
Name:YU, JONG CHIN (LAC)
Entity Type:Individual
Prefix:MR
First Name:JONG
Middle Name:CHIN
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:PO BOX 9627
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-5627
Mailing Address - Country:US
Mailing Address - Phone:671-646-7565
Mailing Address - Fax:671-649-7565
Practice Address - Street 1:263 ADRIAN SANCHEZ STREET
Practice Address - Street 2:
Practice Address - City:HARMON
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-7565
Practice Address - Fax:671-649-7565
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2015-07-14
Deactivation Date:2008-01-09
Deactivation Code:
Reactivation Date:2015-03-31
Provider Licenses
StateLicense IDTaxonomies
GUA15171100000X
CAAC6876171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist