Healthcare Provider Details

I. General information

NPI: 1255492070
Provider Name (Legal Business Name): WOOCHUL JUNG L AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 MORRIS PARK AVE
BRONX NY
10461-1453
US

IV. Provider business mailing address

1053 MORRIS PARK AVE
BRONX NY
10461-1453
US

V. Phone/Fax

Practice location:
  • Phone: 646-872-0183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: