Provider Demographics
NPI:1700229978
Name:JANG, SOYOUNG (LAC)
Entity Type:Individual
Prefix:
First Name:SOYOUNG
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 36TH AVE
Mailing Address - Street 2:APT 3R
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2209
Mailing Address - Country:US
Mailing Address - Phone:917-670-1071
Mailing Address - Fax:
Practice Address - Street 1:3210 36TH AVE
Practice Address - Street 2:APT3R
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2209
Practice Address - Country:US
Practice Address - Phone:917-670-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004997171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist