Provider Demographics
NPI:1841319001
Name:YI, BONGCHOON (DC)
Entity type:Individual
Prefix:DR
First Name:BONGCHOON
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:22315 HIGHWAY 99
Mailing Address - Street 2:#B
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8003
Mailing Address - Country:US
Mailing Address - Phone:425-712-0307
Mailing Address - Fax:425-749-7102
Practice Address - Street 1:22315 HIGHWAY 99
Practice Address - Street 2:#B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8003
Practice Address - Country:US
Practice Address - Phone:425-712-0307
Practice Address - Fax:425-749-7102
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH34226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH34226OtherWASHINGTON LICENSE