MEDICARE: DONG E ACUPUNCTURE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073097713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONG E ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	80 HENDERSON RD
Second Line	:
City	:	KENDALL PARK
State	:	NJ
Zip	:	08824-1509
Country	:	US
Telephone Number	:	732-422-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 HENDERSON RD
Second Line	:
City	:	KENDALL PARK
State	:	NJ
Zip	:	08824-1509
Country	:	US
Telephone Number	:	732-422-7101
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. BRANDON YOON
Credential	:	ACUPUNCTURIST
Telephone Number	:	732-422-7101

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	09/19/2018

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