Provider Demographics
NPI:1649464512
Name:YI, YONG KI
Entity type:Individual
Prefix:
First Name:YONG KI
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22618 HWY 99
Mailing Address - Street 2:#107
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8395
Mailing Address - Country:US
Mailing Address - Phone:425-778-7771
Mailing Address - Fax:425-778-5770
Practice Address - Street 1:22618 HWY 99
Practice Address - Street 2:#107
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8395
Practice Address - Country:US
Practice Address - Phone:425-778-7771
Practice Address - Fax:425-778-5770
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000694171100000X
CAAC6718171100000X
VA0121000183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist