Healthcare Provider Details

I. General information

NPI: 1225546922
Provider Name (Legal Business Name): CHUNGMOO HUH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date: 01/03/2020
Reactivation Date: 02/19/2020

III. Provider practice location address

1634 PONSI ST
FORT LEE NJ
07024-2524
US

IV. Provider business mailing address

1634 PONSI ST
FORT LEE NJ
07024-2524
US

V. Phone/Fax

Practice location:
  • Phone: 347-450-8241
  • Fax:
Mailing address:
  • Phone: 347-450-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00127400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: