Provider Demographics
NPI:1013291731
Name:SHIN, SEUNG HO (LAC)
Entity Type:Individual
Prefix:MR
First Name:SEUNG
Middle Name:HO
Last Name:SHIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2027 CENTER AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4707
Mailing Address - Country:US
Mailing Address - Phone:201-363-1400
Mailing Address - Fax:201-363-1401
Practice Address - Street 1:2027 CENTER AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4707
Practice Address - Country:US
Practice Address - Phone:201-363-1400
Practice Address - Fax:201-363-1401
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00079300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist