Provider Demographics
NPI:1770623720
Name:YI, KEVIN (MED, CRC, CVE)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:MED, CRC, CVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-0028
Mailing Address - Country:US
Mailing Address - Phone:330-678-1147
Mailing Address - Fax:330-678-1148
Practice Address - Street 1:456 WOLCOTT AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2356
Practice Address - Country:US
Practice Address - Phone:330-678-1147
Practice Address - Fax:330-678-1148
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator