Healthcare Provider Details

I. General information

NPI: 1235432675
Provider Name (Legal Business Name): HONGIK ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4561 BELL BLVD
BAYSIDE NY
11361
US

IV. Provider business mailing address

4561 BELL BLVD
BAYSIDE NY
11361
US

V. Phone/Fax

Practice location:
  • Phone: 718-316-8663
  • Fax:
Mailing address:
  • Phone: 718-316-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002546
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number018509
License Number StateNY

VIII. Authorized Official

Name: MRS. AEJA KIM
Title or Position: ACUPUNCTURIST/PRESIDENT
Credential: LAC
Phone: 718-316-8663