Provider Demographics
NPI:1871767855
Name:YI, MI SUN (DC)
Entity type:Individual
Prefix:MISS
First Name:MI SUN
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 NEWPORT BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3786
Mailing Address - Country:US
Mailing Address - Phone:949-650-4362
Mailing Address - Fax:949-650-4366
Practice Address - Street 1:1640 NEWPORT BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:949-650-4362
Practice Address - Fax:949-650-4366
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor