Healthcare Provider Details

I. General information

NPI: 1548124340
Provider Name (Legal Business Name): HEESUN NAM LIC. ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 96TH ST
NEW YORK NY
10128-3835
US

IV. Provider business mailing address

215 E 96TH ST
NEW YORK NY
10128-3835
US

V. Phone/Fax

Practice location:
  • Phone: 917-952-4704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: