Healthcare Provider Details

I. General information

NPI: 1972489961
Provider Name (Legal Business Name): PURE BODY THERAPEUTIC ACUPUNCTURE AND MASSAGE THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 N WANTAGH AVE
BETHPAGE NY
11714-4100
US

IV. Provider business mailing address

6700 192ND ST APT 412
FRESH MEADOWS NY
11365-3735
US

V. Phone/Fax

Practice location:
  • Phone: 631-949-4811
  • Fax:
Mailing address:
  • Phone: 631-949-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: SUHYUN AHN
Title or Position: OWNER
Credential:
Phone: 917-915-1138