Provider Demographics
NPI:1700356532
Name:SEONG, GOOKJIN (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:GOOKJIN
Middle Name:
Last Name:SEONG
Suffix:
Gender:M
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MUNN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3913
Mailing Address - Country:US
Mailing Address - Phone:201-456-1381
Mailing Address - Fax:
Practice Address - Street 1:142 MUNN AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3913
Practice Address - Country:US
Practice Address - Phone:201-456-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00147400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty