Basic Information
| Provider Information | |||||||||
| NPI: | 1376672139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YI | ||||||||
| FirstName: | CHI HEON | ||||||||
| MiddleName: | |||||||||
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| Credential: | L. AC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 CLARMAR RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130661602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154461077 | ||||||||
| FaxNumber: | 3152952208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 E GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154461077 | ||||||||
| FaxNumber: | 3152952208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 10/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 002224 | NY | Y | Other Service Providers | Acupuncturist |
No ID Information.