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General NPI Number Information
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NPI Number | 1619207271
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Entity Type | Individual
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Provider Name | KE JIN L.AC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 1195 MAIN AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-2242
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Country | US
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Telephone | 732-823-7219
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Fax |
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Provider Business Mailing Address
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Address Line | 275 E MOUNT PLEASANT AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3210
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Country | US
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Telephone | 732-823-7219
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00071100
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License Number State | NJ
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