Provider Demographics
NPI:1992031090
Name:YI, MINJAE (LAC)
Entity Type:Individual
Prefix:PROF
First Name:MINJAE
Middle Name:
Last Name:YI
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 1:6226 E SPRING ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1438
Mailing Address - Country:US
Mailing Address - Phone:562-419-9275
Mailing Address - Fax:
Practice Address - Street 1:6226 E SPRING ST STE 300
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1438
Practice Address - Country:US
Practice Address - Phone:562-419-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6767171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist