1043603624 NPI number — YINYANG 5 ELEMENTS ACUPUNCTURE, P.C.

Table of content: DR. ROSHAYE SHERRICE GRAHAM MD (NPI 1053016568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043603624 NPI number — YINYANG 5 ELEMENTS ACUPUNCTURE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YINYANG 5 ELEMENTS ACUPUNCTURE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043603624
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13682 39TH AVE
Provider Second Line Business Mailing Address:
6TH FLOOR
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11354-5515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-445-2346
Provider Business Mailing Address Fax Number:
718-445-2348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13682 39TH AVE
Provider Second Line Business Practice Location Address:
6TH FLOOR
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-5515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-445-2346
Provider Business Practice Location Address Fax Number:
718-445-2348
Provider Enumeration Date:
03/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CHOI
Authorized Official First Name:
HYEONJU
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-445-2346

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  003521-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com