Provider Demographics
NPI:1326421678
Name:DAE WON ACUPUNCTURE PC
Entity Type:Organization
Organization Name:DAE WON ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-321-0875
Mailing Address - Street 1:16315 NORTHERN BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2667
Mailing Address - Country:US
Mailing Address - Phone:718-321-0875
Mailing Address - Fax:
Practice Address - Street 1:16315 NORTHERN BLVD
Practice Address - Street 2:STE 3
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2667
Practice Address - Country:US
Practice Address - Phone:718-321-0875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004533171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty