Provider Demographics
NPI:1174966006
Name:CHUNG, JEENIE MIYOUNG (LAC)
Entity type:Individual
Prefix:
First Name:JEENIE
Middle Name:MIYOUNG
Last Name:CHUNG
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4136
Mailing Address - Country:US
Mailing Address - Phone:212-935-1700
Mailing Address - Fax:212-753-9856
Practice Address - Street 1:300 E 56TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4136
Practice Address - Country:US
Practice Address - Phone:212-935-1700
Practice Address - Fax:212-753-9856
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004955-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist