Provider Demographics
NPI:1376290882
Name:BK ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:BK ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BONGKYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:262-754-8040
Mailing Address - Street 1:12555 W NATIONAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4061
Mailing Address - Country:US
Mailing Address - Phone:262-754-8040
Mailing Address - Fax:262-754-8040
Practice Address - Street 1:12555 W NATIONAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4061
Practice Address - Country:US
Practice Address - Phone:262-754-8040
Practice Address - Fax:262-754-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty