MEDICARE: SHI WOO ACUPUNCTURE AND WELLNESS

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		NY

General Provider Information

NPI Number	:	1932601028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHI WOO ACUPUNCTURE AND WELLNESS

Provider Business Mailing Address
First Line	:	75 E FORT UNION BLVD STE 150
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-1531
Country	:	US
Telephone Number	:	801-900-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 E FORT UNION BLVD STE 150
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-1531
Country	:	US
Telephone Number	:	801-900-7733
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANGAE KIM
Credential	:	LAC
Telephone Number	:	801-900-7733

Provider Enumeration Date	:	03/05/2018
Last Update Date	:	03/15/2024

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