Provider Demographics
NPI:1912779257
Name:JEONG, JIN SUN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JIN SUN
Middle Name:
Last Name:JEONG
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 JUNIPER RD FL 2
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1435
Mailing Address - Country:US
Mailing Address - Phone:516-672-6794
Mailing Address - Fax:
Practice Address - Street 1:34 JUNIPER RD FL 2
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1435
Practice Address - Country:US
Practice Address - Phone:516-672-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007413-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist