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General NPI Number Information
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NPI Number | 1912779257
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Entity Type | Individual
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Provider Name | JIN SUN JEONG ACUPUNCTURIST
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Gender | Female
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 34 JUNIPER RD FL 2
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-1435
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Country | US
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Telephone | 516-672-6794
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Fax |
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Provider Business Mailing Address
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Address Line | 34 JUNIPER RD FL 2
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-1435
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Country | US
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Telephone | 516-672-6794
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 007413-01
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License Number State | NY
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