Provider Demographics
NPI:1972960391
Name:SHIN, YONG K (L AC)
Entity Type:Individual
Prefix:
First Name:YONG
Middle Name:K
Last Name:SHIN
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 OLD RICHMOND AVE STE C11
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1828
Mailing Address - Country:US
Mailing Address - Phone:804-803-3001
Mailing Address - Fax:804-902-2849
Practice Address - Street 1:5700 OLD RICHMOND AVE STE C11
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-803-3001
Practice Address - Fax:804-902-2849
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18201171100000X
VA0121001034171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist