Provider Demographics
NPI:1821742628
Name:OLIVE TREE ACUPUNCTURE P.C.
Entity Type:Organization
Organization Name:OLIVE TREE ACUPUNCTURE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAECHOL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:646-755-9255
Mailing Address - Street 1:14241 41ST AVE UNIT 9
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2451
Mailing Address - Country:US
Mailing Address - Phone:646-755-9255
Mailing Address - Fax:646-666-9427
Practice Address - Street 1:14241 41ST AVE UNIT 9
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2451
Practice Address - Country:US
Practice Address - Phone:646-755-9255
Practice Address - Fax:646-666-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty