Healthcare Provider Details

I. General information

NPI: 1578132411
Provider Name (Legal Business Name): DONGWON ACUPUNCTURE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DEMPSTER ST STE 206
PARK RIDGE IL
60068-1172
US

IV. Provider business mailing address

1600 DEMPSTER ST STE 206
PARK RIDGE IL
60068-1172
US

V. Phone/Fax

Practice location:
  • Phone: 224-938-9521
  • Fax:
Mailing address:
  • Phone: 224-410-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD KIM
Title or Position: CLINICAL DIRECTOR
Credential: L.AC
Phone: 224-938-9521