Provider Demographics
NPI:1467701896
Name:REGEN ACUPUNCTURE PC
Entity Type:Organization
Organization Name:REGEN ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TAEHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:718-285-3046
Mailing Address - Street 1:143-30 38TH AVE.
Mailing Address - Street 2:SUITE 1L
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5720
Mailing Address - Country:US
Mailing Address - Phone:718-285-3046
Mailing Address - Fax:718-285-3047
Practice Address - Street 1:143-30 38TH AVE.
Practice Address - Street 2:SUITE 1L
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5720
Practice Address - Country:US
Practice Address - Phone:718-285-3046
Practice Address - Fax:718-285-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004677-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty