=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649653676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE ACUPUNCTURE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2015
-----------------------------------------------------
Last Update Date | 07/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 BROAD AVE
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07657-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-840-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 BROAD AVE
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07657-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | MYUNG H YU
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 201-233-5742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 25MZ00107100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------