Provider Demographics
NPI:1245362136
Name:TAE, MYUNG SUK (DOM, AP)
Entity type:Individual
Prefix:
First Name:MYUNG
Middle Name:SUK
Last Name:TAE
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N FEDERAL HWY
Mailing Address - Street 2:SUITE D304
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5188
Mailing Address - Country:US
Mailing Address - Phone:561-338-3337
Mailing Address - Fax:561-338-4805
Practice Address - Street 1:4800 N FEDERAL HWY
Practice Address - Street 2:SUITE D304
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5188
Practice Address - Country:US
Practice Address - Phone:561-338-3337
Practice Address - Fax:561-338-4805
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1195171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP1195OtherACUPUNCTURE