Provider Demographics
NPI:1942666417
Name:SIMPLE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:SIMPLE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-768-0255
Mailing Address - Street 1:120 COUNTY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1854
Mailing Address - Country:US
Mailing Address - Phone:201-768-0255
Mailing Address - Fax:
Practice Address - Street 1:120 COUNTY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1854
Practice Address - Country:US
Practice Address - Phone:201-768-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00043100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty