MEDICARE: GANGLIN 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	225700000X	Massage Therapist	173452	OK

General Provider Information

NPI Number	:	1538794599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GANGLIN YI

Provider Business Mailing Address
First Line	:	417 MADISON CT
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-6744
Country	:	US
Telephone Number	:	405-293-8668
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 N MERIDIAN AVE STE 6
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2137
Country	:	US
Telephone Number	:	405-293-8668
Fax Number	:

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

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	03/10/2020

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Directions to “ GANGLIN YI ” Practice Location

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