Provider Demographics
NPI:1457645541
Name:WOORI ACUPUNCTURE MEDICAL
Entity Type:Organization
Organization Name:WOORI ACUPUNCTURE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KONG
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:678-473-9454
Mailing Address - Street 1:3761 VENTURE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5528
Mailing Address - Country:US
Mailing Address - Phone:678-473-9454
Mailing Address - Fax:678-473-9453
Practice Address - Street 1:3761 VENTURE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5528
Practice Address - Country:US
Practice Address - Phone:678-473-9454
Practice Address - Fax:678-473-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA193320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities