Provider Demographics
NPI:1649539347
Name:BOLTON, YONG SUN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:SUN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:YONG
Other - Middle Name:SUN
Other - Last Name:RO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:11620 BROOK HILL CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1969
Mailing Address - Country:US
Mailing Address - Phone:907-202-3589
Mailing Address - Fax:
Practice Address - Street 1:4050 LAKE OTIS PKWY STE 201B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5223
Practice Address - Country:US
Practice Address - Phone:907-202-3589
Practice Address - Fax:907-334-1015
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT:12513225700000X, 173C00000X
AK101896225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist