Provider Demographics
NPI:1558058461
Name:NY WHITE TIGER ACUPUNCTURE PC
Entity Type:Organization
Organization Name:NY WHITE TIGER ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BACKHO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:347-507-0642
Mailing Address - Street 1:6019 ROOSEVELT AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4375
Mailing Address - Country:US
Mailing Address - Phone:347-507-0642
Mailing Address - Fax:
Practice Address - Street 1:6019 ROOSEVELT AVE STE 221
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4375
Practice Address - Country:US
Practice Address - Phone:347-507-0642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty