Healthcare Provider Details

I. General information

NPI: 1356292957
Provider Name (Legal Business Name): ELIM ACUPUNCTURE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 E GRAYSTONE WAY STE 7
SALT LAKE CITY UT
84106-2671
US

IV. Provider business mailing address

1734 E 2100 S
SALT LAKE CITY UT
84106-4142
US

V. Phone/Fax

Practice location:
  • Phone: 801-554-5587
  • Fax: 801-880-8776
Mailing address:
  • Phone: 801-554-5587
  • Fax: 801-880-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JU HYEON LEE
Title or Position: OWNER
Credential: L.AC
Phone: 801-554-5587