Healthcare Provider Details

I. General information

NPI: 1477014231
Provider Name (Legal Business Name): ACUPUNTURE ONE WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VALLEY RD STE 101
WAYNE NJ
07470-3551
US

IV. Provider business mailing address

101 TERRACE AVE APT 5D
HASBROUCK HTS NJ
07604-2449
US

V. Phone/Fax

Practice location:
  • Phone: 732-788-5504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MIN JAE CHUNG
Title or Position: ACUPUNCTURIST
Credential: LAC
Phone: 732-788-5504