Healthcare Provider Details

I. General information

NPI: 1396927810
Provider Name (Legal Business Name): TAISUK YI L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 SEPULVEDA BLVD
TORRANCE CA
90505-2803
US

IV. Provider business mailing address

2820 SEPULVEDA BLVD
TORRANCE CA
90505-2803
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-8500
  • Fax: 310-325-8502
Mailing address:
  • Phone: 310-325-8500
  • Fax: 310-325-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: