Provider Demographics
NPI:1750665410
Name:HARRISON, HYUN JUNG (LAC)
Entity Type:Individual
Prefix:
First Name:HYUN JUNG
Middle Name:
Last Name:HARRISON
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 1:840 MONROE TPKE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1962
Mailing Address - Country:US
Mailing Address - Phone:203-261-2348
Mailing Address - Fax:
Practice Address - Street 1:840 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1962
Practice Address - Country:US
Practice Address - Phone:203-220-8879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000398171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist