Provider Demographics
NPI:1164250569
Name:SYMPHONY ACUPUNCTURE PC
Entity type:Organization
Organization Name:SYMPHONY ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JUNG-TAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-400-0600
Mailing Address - Street 1:41-23 MURRAY ST #205
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1048
Mailing Address - Country:US
Mailing Address - Phone:917-400-0600
Mailing Address - Fax:
Practice Address - Street 1:41-23 MURRAY ST #205
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1048
Practice Address - Country:US
Practice Address - Phone:917-400-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006405-01OtherLICENSE