Provider Demographics
NPI:1396982484
Name:YI, JUNG WOO (ACUPUNCTURIST)
Entity type:Individual
Prefix:MR
First Name:JUNG
Middle Name:WOO
Last Name:YI
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 CALUMET AVE
Mailing Address - Street 2:SUITE #204
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:714-315-8047
Mailing Address - Fax:
Practice Address - Street 1:8400 CALUMET AVE
Practice Address - Street 2:SUITE #204
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:714-315-8047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12581171100000X
IN84000124A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist