Basic Information
| Provider Information | |||||||||
| NPI: | 1477047744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EE | ||||||||
| FirstName: | SUNG | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 FIREMENS MEMORIAL DR STE 115 | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109703569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453628400 | ||||||||
| FaxNumber: | 8453628474 | ||||||||
| Practice Location | |||||||||
| Address1: | 1075 CENTRAL PARK AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | SCARSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105833241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144722700 | ||||||||
| FaxNumber: | 8453628474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2018 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 004411 | NY | Y | Other Service Providers | Acupuncturist |
No ID Information.