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General NPI Number Information
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NPI Number | 1558896373
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Entity Type | Individual
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Provider Name | JEHYUN WOO LAC
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Gender | Male
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Dates
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Enumeration Date | 04/30/2017
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 25220 NORTHERN BLVD STE 202
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City | LITTLE NECK
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State | NY
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Zip | 11362-1344
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Country | US
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Telephone | 347-836-8914
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Fax | 478-354-8703
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Provider Business Mailing Address
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Address Line | 20935 NORTHERN BLVD SUITE 215
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City | BAYSIDE
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State | NY
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Zip | 11361-3134
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Country | US
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Telephone | 718-225-9000
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Fax | 718-352-9000
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005752
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License Number State | NY
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