=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700203924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOON ACUPUNCTURE P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2014
-----------------------------------------------------
Last Update Date | 02/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 849 57TH STREET SUITE 802
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-576-6882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 WINSTON DR APT 2112
-----------------------------------------------------
City | CLIFFSIDE PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-407-5982
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHANG JOON WON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-407-5982
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 005242
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------