Healthcare Provider Details

I. General information

NPI: 1679700793
Provider Name (Legal Business Name): HORYUL AN L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADWAY STE 1630A
NEW YORK NY
10007-3001
US

IV. Provider business mailing address

225 BROADWAY STE 1630A
NEW YORK NY
10007-3001
US

V. Phone/Fax

Practice location:
  • Phone: 551-359-6135
  • Fax: 917-994-9580
Mailing address:
  • Phone: 551-359-6135
  • Fax: 917-994-9580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004969
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: