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General NPI Number Information
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NPI Number | 1023373685
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Entity Type | Individual
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Provider Name | JONGKOO AHN LAC,LMT
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Gender | Male
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 215 HALLOCK RD STE 6A
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City | STONY BROOK
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State | NY
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Zip | 11790
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Country | US
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Telephone | 917-563-1824
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Fax | 929-900-1843
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Provider Business Mailing Address
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Address Line | 215 HALLOCK RD STE 6A
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City | STONY BROOK
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State | NY
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Zip | 11790-3077
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Country | US
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Telephone | 917-563-1824
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Fax | 929-900-1843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 025164
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 003747
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License Number State | NY
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