Healthcare Provider Details

I. General information

NPI: 1336651280
Provider Name (Legal Business Name): HEE KYUNG JEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35202 GAWAIN CT
FREMONT CA
94536-2418
US

IV. Provider business mailing address

35202 GAWAIN CT
FREMONT CA
94536-2418
US

V. Phone/Fax

Practice location:
  • Phone: 510-896-9164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: