Provider Demographics
NPI:1801362207
Name:EASTERN SUN ACUPUNCTURE
Entity Type:Organization
Organization Name:EASTERN SUN ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YONEYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-765-2100
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0523
Mailing Address - Country:US
Mailing Address - Phone:631-765-2100
Mailing Address - Fax:
Practice Address - Street 1:53345 MAIN RD STE 6-1
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4643
Practice Address - Country:US
Practice Address - Phone:631-765-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1053705798OtherLAC