Provider Demographics
NPI:1770013997
Name:RHEE, TOM TAEHUN (L AC)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:TAEHUN
Last Name:RHEE
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 121ST ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1149
Mailing Address - Country:US
Mailing Address - Phone:917-887-9900
Mailing Address - Fax:
Practice Address - Street 1:141-41 NORTHERN BLVD
Practice Address - Street 2:#2FL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-353-4560
Practice Address - Fax:347-506-0252
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006021171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006021OtherL. AC.
NY025280OtherMASSAGE THERAPY