Provider Demographics
NPI:1972012136
Name:CHOI, JUNGMIN (LAC)
Entity Type:Individual
Prefix:
First Name:JUNGMIN
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 149TH PL FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4919
Mailing Address - Country:US
Mailing Address - Phone:718-909-1803
Mailing Address - Fax:
Practice Address - Street 1:2818 31ST ST FL 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1745
Practice Address - Country:US
Practice Address - Phone:718-909-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005764171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist