Provider Demographics
NPI:1922425131
Name:WON, CHANG JOON
Entity Type:Individual
Prefix:
First Name:CHANG JOON
Middle Name:
Last Name:WON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WINSTON DR
Mailing Address - Street 2:APT 2112
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3225
Mailing Address - Country:US
Mailing Address - Phone:917-407-5982
Mailing Address - Fax:
Practice Address - Street 1:3622 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:917-563-5820
Practice Address - Fax:917-563-5819
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005242171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist