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General NPI Number Information
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NPI Number | 1629427695
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Entity Type | Organization
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Legal Business Name | DONGHWAN'S ACU AND HERB INC
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 1841 BROADWAY SUITE 505
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City | NEW YORK
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State | NY
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Zip | 10023-7603
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Country | US
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Telephone | 917-881-9304
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Fax | 800-404-9837
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Provider Business Mailing Address
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Address Line | 1841 BROADWAY SUITE 505
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City | NEW YORK
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State | NY
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Zip | 10023-7603
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Country | US
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Telephone | 917-881-9304
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Fax | 800-404-9837
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | DONGHWAN LEE
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Credential | L.AC
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Telephone | 917-881-9304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 005653
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License Number State | NY
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