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General NPI Number Information
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NPI Number | 1689212219
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Entity Type | Organization
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Legal Business Name | GRACEFUL LOTUS ACUPUNCTURE , P.C.
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 42 W 38TH ST RM 1204
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City | NEW YORK
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State | NY
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Zip | 10018-0054
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Country | US
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Telephone | 212-320-3722
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Fax |
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Provider Business Mailing Address
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Address Line | 6707 242ND ST APT 3F
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City | DOUGLASTON
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State | NY
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Zip | 11362-1998
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | JIYUN SHIN
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Credential | LAC
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Telephone | 917-670-1500
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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 |
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License Number State |
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