Provider Demographics
NPI:1033508296
Name:BETHESDA ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:BETHESDA ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SO
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-977-1017
Mailing Address - Street 1:663 GRAND AVE
Mailing Address - Street 2:#1
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1521
Mailing Address - Country:US
Mailing Address - Phone:201-977-1017
Mailing Address - Fax:
Practice Address - Street 1:663 GRAND AVE
Practice Address - Street 2:#1
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1521
Practice Address - Country:US
Practice Address - Phone:201-977-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty