=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912164682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YUN-SUN YANG D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6777 N 5TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19126-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-687-7030
-----------------------------------------------------
Fax | 215-276-1692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6777 N 5TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19126-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-687-7030
-----------------------------------------------------
Fax | 215-276-1692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC009108
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------