MEDICARE: KJ ACU & HERBS CORP.

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	261QH0100X	Health Service Clinic/Center	25MZ00080100	NJ

General Provider Information

NPI Number	:	1205245933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KJ ACU & HERBS CORP.

Provider Business Mailing Address
First Line	:	6432 224TH ST
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6432 224TH ST
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2318
Country	:	US
Telephone Number	:	646-670-8155
Fax Number	:

Authorized Official
Title or Position	:	M.S. IN HEALTH SCIENCE/OM
Name	:	MARY LEE
Credential	:
Telephone Number	:	646-670-8155

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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