Healthcare Provider Details

I. General information

NPI: 1043162639
Provider Name (Legal Business Name): PATRICIA EUN HYUN RI DAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 NORTHERN BLVD STE 7
GREAT NECK NY
11021-4803
US

IV. Provider business mailing address

425 NORTHERN BLVD STE 7
GREAT NECK NY
11021-4803
US

V. Phone/Fax

Practice location:
  • Phone: 646-787-7100
  • Fax:
Mailing address:
  • Phone: 646-787-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: