Healthcare Provider Details

I. General information

NPI: 1255534962
Provider Name (Legal Business Name): AILIN KOJIMA L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W 29TH ST RM 1103
NEW YORK NY
10001-5224
US

IV. Provider business mailing address

240 W 102ND ST APT. 55
NEW YORK NY
10025-4900
US

V. Phone/Fax

Practice location:
  • Phone: 917-859-7506
  • Fax:
Mailing address:
  • Phone: 917-859-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: