Healthcare Provider Details

I. General information

NPI: 1679349120
Provider Name (Legal Business Name): GA HYUN MOON L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 US HIGHWAY 46
WAYNE NJ
07470-6831
US

IV. Provider business mailing address

155 US HIGHWAY 46 STE 300
WAYNE NJ
07470-6836
US

V. Phone/Fax

Practice location:
  • Phone: 862-666-9285
  • Fax:
Mailing address:
  • Phone: 862-666-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00168500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: