Provider Demographics
NPI:1346362332
Name:CHOI, TAE-YOUNG J (LAC)
Entity Type:Individual
Prefix:
First Name:TAE-YOUNG
Middle Name:J
Last Name:CHOI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:62 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1867
Mailing Address - Country:US
Mailing Address - Phone:908-930-2678
Mailing Address - Fax:732-482-1731
Practice Address - Street 1:400 SWENSON DR
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1323
Practice Address - Country:US
Practice Address - Phone:908-930-2678
Practice Address - Fax:732-482-1731
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00037600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist