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General NPI Number Information
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NPI Number | 1841582277
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Entity Type | Organization
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Legal Business Name | MJ NATURAL WELLNESS LLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 436 MAIN AVE
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City | WALLINGTON
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State | NJ
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Zip | 07057-1830
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Country | US
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Telephone | 917-609-3281
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Fax |
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Provider Business Mailing Address
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Address Line | 538 PORTSIDE DR
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City | EDGEWATER
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State | NJ
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Zip | 07020-1168
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Country | US
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Telephone | 917-609-3281
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Fax | 201-224-6608
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOHYUN KIM
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Credential | L.AC.
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Telephone | 917-609-3281
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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 | 25MZ00046000
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License Number State | NJ
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