Provider Demographics
NPI:1679033674
Name:GRACE ACUPUNCTURE AND ORIENTAL MEDICINE
Entity Type:Organization
Organization Name:GRACE ACUPUNCTURE AND ORIENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:SEUNGHEE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:781-861-0560
Mailing Address - Street 1:442 MARRETT RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7749
Mailing Address - Country:US
Mailing Address - Phone:781-861-0560
Mailing Address - Fax:781-810-8799
Practice Address - Street 1:442 MARRETT RD STE 6
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7749
Practice Address - Country:US
Practice Address - Phone:781-861-0560
Practice Address - Fax:781-810-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA250192OtherSTATE LICENSE
026496OtherNCCAOM