Provider Demographics
NPI:1376141077
Name:PRIME ACUPUNCTURE CLINIC, LLC
Entity Type:Organization
Organization Name:PRIME ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SOOJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEOM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-408-5181
Mailing Address - Street 1:85 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3026
Mailing Address - Country:US
Mailing Address - Phone:201-407-4411
Mailing Address - Fax:
Practice Address - Street 1:71 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3531
Practice Address - Country:US
Practice Address - Phone:201-408-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty