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General NPI Number Information
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NPI Number | 1023524956
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Entity Type | Individual
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Provider Name | KYONG SU HAN LAC
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Gender | Male
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 100 ROUTE 303
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City | TAPPAN
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State | NY
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Zip | 10983-2117
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Country | US
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Telephone | 845-680-6294
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Fax |
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Provider Business Mailing Address
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Address Line | 2449B ROSSETT ST
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City | FORT LEE
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State | NJ
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Zip | 07024-3919
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Country | US
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Telephone | 201-240-2488
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Fax |
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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 | 025130-1
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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 | 006038-1
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License Number State | NY
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