Provider Demographics
NPI:1437458908
Name:KEUM, WON KYUNG (CA)
Entity Type:Individual
Prefix:MRS
First Name:WON KYUNG
Middle Name:
Last Name:KEUM
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LIBERTY ST
Mailing Address - Street 2:UNIT 28
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1763
Mailing Address - Country:US
Mailing Address - Phone:732-718-9530
Mailing Address - Fax:
Practice Address - Street 1:137 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1203
Practice Address - Country:US
Practice Address - Phone:732-718-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00045400171100000X
NY002765171100000X
PAAK000790171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist