Provider Demographics
NPI:1093049363
Name:FOREST ACUPUNCTURE & HERB INC
Entity Type:Organization
Organization Name:FOREST ACUPUNCTURE & HERB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-363-0233
Mailing Address - Street 1:119 CLIFFORD ST
Mailing Address - Street 2:#105
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1908
Mailing Address - Country:US
Mailing Address - Phone:201-363-0233
Mailing Address - Fax:
Practice Address - Street 1:119 CLIFFORD ST
Practice Address - Street 2:#105
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1908
Practice Address - Country:US
Practice Address - Phone:201-363-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMZ00045000302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization