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General NPI Number Information
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NPI Number | 1962943100
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Entity Type | Individual
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Provider Name | JIYUN SHIN LAC
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Gender | Female
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 42 W 38TH ST RM 1204
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City | NEW YORK
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State | NY
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Zip | 10018-0054
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Country | US
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Telephone | 212-320-3722
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Fax |
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Provider Business Mailing Address
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Address Line | 6707 242ND ST APT 3F
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City | DOUGLASTON
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State | NY
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Zip | 11362-1998
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Country | US
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Telephone | 917-670-1500
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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 | 005876
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License Number State | NY
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