Healthcare Provider Details

I. General information

NPI: 1184435109
Provider Name (Legal Business Name): YIWELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 OLD HENDERSON RD STE A
COLUMBUS OH
43220-3694
US

IV. Provider business mailing address

1194 OLD HENDERSON RD STE A
COLUMBUS OH
43220-3694
US

V. Phone/Fax

Practice location:
  • Phone: 614-869-0085
  • Fax: 614-869-0083
Mailing address:
  • Phone: 614-869-0085
  • Fax: 614-869-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY GUAN
Title or Position: CEO
Credential: MD
Phone: 917-754-0980