Provider Demographics
NPI:1881936615
Name:YU, KEVIN (LAC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 S EVERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8657
Mailing Address - Country:US
Mailing Address - Phone:561-866-8814
Mailing Address - Fax:
Practice Address - Street 1:902 W INDIANTOWN RD
Practice Address - Street 2:SUITE 20
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4373
Practice Address - Country:US
Practice Address - Phone:561-866-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3064171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist