Provider Demographics
NPI:1275993206
Name:GAON ACUPUNCTURE, P.C.
Entity Type:Organization
Organization Name:GAON ACUPUNCTURE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YOUNGJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:646-641-3220
Mailing Address - Street 1:17543 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5724
Mailing Address - Country:US
Mailing Address - Phone:646-413-2200
Mailing Address - Fax:
Practice Address - Street 1:17325 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5523
Practice Address - Country:US
Practice Address - Phone:718-285-6054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty