Provider Demographics
NPI:1790198067
Name:PYUN, MINA (LAC)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:PYUN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MINA
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1075 CENTRAL PARK AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3232
Mailing Address - Country:US
Mailing Address - Phone:914-713-8732
Mailing Address - Fax:914-713-8733
Practice Address - Street 1:1075 CENTRAL PARK AVE STE 401
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3232
Practice Address - Country:US
Practice Address - Phone:914-713-8732
Practice Address - Fax:914-713-8733
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist