Healthcare Provider Details

I. General information

NPI: 1477856623
Provider Name (Legal Business Name): JACQUELINE SUN HEE YANG N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 STILES RD STE 210
SALEM NH
03079-2846
US

IV. Provider business mailing address

23 STILES ROAD STE 210
SALEM NH
03079
US

V. Phone/Fax

Practice location:
  • Phone: 603-458-6579
  • Fax:
Mailing address:
  • Phone: 603-458-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number076
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: