=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073822078
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOUNG SUN MOON L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2010
-----------------------------------------------------
Last Update Date | 04/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 344 LINCOLN AVE # RR
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07506-1258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-503-5888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 PARK PL APT 1A
-----------------------------------------------------
City | FORT LEE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07024-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-982-0615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 25MZ00070900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------