Provider Demographics
NPI:1003501982
Name:JEONG, YOUNGSIK (LAC)
Entity type:Individual
Prefix:MR
First Name:YOUNGSIK
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19780F PECK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2878
Mailing Address - Country:US
Mailing Address - Phone:929-383-3192
Mailing Address - Fax:
Practice Address - Street 1:3058 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5726
Practice Address - Country:US
Practice Address - Phone:718-931-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7261171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist