MEDICARE: JEHYUN WOO LAC

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	171100000X	Acupuncturist	005752	NY

General Provider Information

NPI Number	:	1558896373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEHYUN WOO LAC

Provider Business Mailing Address
First Line	:	20935 NORTHERN BLVD
Second Line	:	SUITE 215
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3134
Country	:	US
Telephone Number	:	718-225-9000
Fax Number	:	718-352-9000

Provider Business Practice Location Address
First Line	:	25220 NORTHERN BLVD STE 202
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-1344
Country	:	US
Telephone Number	:	347-836-8914
Fax Number	:	478-354-8703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2017
Last Update Date	:	11/05/2019

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Directions to “ JEHYUN WOO LAC” Practice Location

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