Provider Demographics
NPI:1720277890
Name:YOO, HAE-JEONG (L AC)
Entity Type:Individual
Prefix:MRS
First Name:HAE-JEONG
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:MRS
Other - First Name:HELEN
Other - Middle Name:H
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3175 N 140 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3832
Mailing Address - Country:US
Mailing Address - Phone:801-500-1583
Mailing Address - Fax:
Practice Address - Street 1:3175 N 140 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3832
Practice Address - Country:US
Practice Address - Phone:801-500-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9125171100000X
UT9853710-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist