Provider Demographics
NPI:1962722413
Name:JOO, JUNG EUN (MSTOM, DAOM, LAC)
Entity type:Individual
Prefix:DR
First Name:JUNG EUN
Middle Name:
Last Name:JOO
Suffix:
Gender:F
Credentials:MSTOM, DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61-20 WOODSIDE AVE.
Mailing Address - Street 2:#1X
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:917-520-3006
Mailing Address - Fax:
Practice Address - Street 1:19 WEST 21 STREET
Practice Address - Street 2:#904
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:917-520-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004340171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist