Provider Demographics
NPI:1639696511
Name:CHO, HYUNYEUL (LAC, DOM)
Entity Type:Individual
Prefix:
First Name:HYUNYEUL
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20105 NORTHERN BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2563
Mailing Address - Country:US
Mailing Address - Phone:929-590-8118
Mailing Address - Fax:347-235-4662
Practice Address - Street 1:20105 NORTHERN BLVD.
Practice Address - Street 2:1 FL
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361
Practice Address - Country:US
Practice Address - Phone:929-590-8118
Practice Address - Fax:347-235-4662
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist