Provider Demographics
NPI:1265791107
Name:YANG, JI SUN (LAC)
Entity type:Individual
Prefix:MRS
First Name:JI SUN
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N DEREK DR APT 227
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1438
Mailing Address - Country:US
Mailing Address - Phone:714-345-3202
Mailing Address - Fax:
Practice Address - Street 1:2001 N DEREK DR APT 227
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1438
Practice Address - Country:US
Practice Address - Phone:714-345-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14857171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist