Provider Demographics
NPI:1871726448
Name:YI, BOKSOON ANGIE (LAC, PHD)
Entity type:Individual
Prefix:
First Name:BOKSOON
Middle Name:ANGIE
Last Name:YI
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 LOMITA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5024
Mailing Address - Country:US
Mailing Address - Phone:310-257-1712
Mailing Address - Fax:
Practice Address - Street 1:3525 LOMITA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5024
Practice Address - Country:US
Practice Address - Phone:310-257-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2980171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist