Healthcare Provider Details

I. General information

NPI: 1669799623
Provider Name (Legal Business Name): KANGSUN ACUPUNCTURE & HERB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 3RD AVE
BRONX NY
10454-1199
US

IV. Provider business mailing address

1239 POST RD
SCARSDALE NY
10583-2132
US

V. Phone/Fax

Practice location:
  • Phone: 718-866-0153
  • Fax: 718-866-0163
Mailing address:
  • Phone: 917-693-8818
  • Fax: 718-866-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003016
License Number StateNY

VIII. Authorized Official

Name: SON H. LEE
Title or Position: LAC
Credential:
Phone: 917-693-8818