Provider Demographics
NPI:1821610262
Name:IM, JIN MYUNG (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:JIN
Middle Name:MYUNG
Last Name:IM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 157TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5024
Mailing Address - Country:US
Mailing Address - Phone:347-536-8238
Mailing Address - Fax:
Practice Address - Street 1:3518 157TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5024
Practice Address - Country:US
Practice Address - Phone:347-536-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006750171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist