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General NPI Number Information
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NPI Number | 1861743882
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Entity Type | Organization
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Legal Business Name | KLK MEDICAL ACUCPUNTURE
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 385 LAKEVIEW AVE STE 4
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City | CLIFTON
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State | NJ
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Zip | 07011-4075
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Country | US
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Telephone | 973-340-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 385 LAKEVIEW AVE STE 4
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City | CLIFTON
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State | NJ
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Zip | 07011-4075
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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 | PRESIDENT
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Name | DONG KEUN LEE
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Credential |
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Telephone | 973-340-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25MZ000812000
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License Number State | NJ
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