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General NPI Number Information
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NPI Number | 1700376233
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Entity Type | Organization
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Legal Business Name | SYNERGY ACUPUNCTURE PC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 11442 SUTPHIN BLVD # 1
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City | JAMAICA
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State | NY
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Zip | 11434-1021
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Country | US
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Telephone | 929-499-3172
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Fax | 929-499-3170
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Provider Business Mailing Address
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Address Line | 11442 SUTPHIN BLVD # 1
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City | JAMAICA
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State | NY
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Zip | 11434-1021
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Country | US
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Telephone | 929-499-3172
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Fax | 929-499-3170
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Authorized Official
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Title or Position | OWNER
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Name | OKKYOUNG PARK-KIM
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Credential | LAC
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Telephone | 929-499-3172
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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 | 003056
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License Number State | NY
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