Provider Demographics
NPI:1700505344
Name:KLEINFELD, JAEYOUNG (LAC)
Entity Type:Individual
Prefix:
First Name:JAEYOUNG
Middle Name:
Last Name:KLEINFELD
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 1:555 GORGE RD APT 6H
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2240
Mailing Address - Country:US
Mailing Address - Phone:201-937-2204
Mailing Address - Fax:
Practice Address - Street 1:555 GORGE RD APT 6H
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2240
Practice Address - Country:US
Practice Address - Phone:201-937-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00162200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist