Provider Demographics
NPI:1477310092
Name:AN, KYEONGMIN (LAC)
Entity Type:Individual
Prefix:
First Name:KYEONGMIN
Middle Name:
Last Name:AN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:270 MARIN BLVD APT 14H
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3682
Mailing Address - Country:US
Mailing Address - Phone:646-753-0025
Mailing Address - Fax:
Practice Address - Street 1:120 E 56TH ST RM 330
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3751
Practice Address - Country:US
Practice Address - Phone:201-494-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist