Provider Demographics
NPI:1356883201
Name:KJ ACU & HERBS CORP.
Entity type:Organization
Organization Name:KJ ACU & HERBS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-670-8155
Mailing Address - Street 1:6432 224TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2318
Mailing Address - Country:US
Mailing Address - Phone:646-670-8155
Mailing Address - Fax:
Practice Address - Street 1:6432 224TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2318
Practice Address - Country:US
Practice Address - Phone:646-670-8155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00080100302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization