Provider Demographics
NPI:1972837060
Name:TING, YAN HOI (LAC)
Entity Type:Individual
Prefix:MS
First Name:YAN
Middle Name:HOI
Last Name:TING
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 POCONO RD
Mailing Address - Street 2:950
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-9998
Mailing Address - Country:US
Mailing Address - Phone:203-558-6169
Mailing Address - Fax:
Practice Address - Street 1:52 HUCKLEBERRY HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2211
Practice Address - Country:US
Practice Address - Phone:203-558-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT515171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1972837060Medicaid