MEDICARE: JEAN YI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-22-59366	NC

General Provider Information

NPI Number	:	1477178937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN YI

Provider Business Mailing Address
First Line	:	2907 DARK BRANCH RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3718
Country	:	US
Telephone Number	:	718-316-5358
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 DARK BRANCH RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3718
Country	:	US
Telephone Number	:	718-316-5358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	05/26/2026

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Directions to “ JEAN YI ” Practice Location

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