Provider Demographics
NPI:1184059628
Name:CHUNG, SOJIN (LAC)
Entity type:Individual
Prefix:
First Name:SOJIN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1635 BELL BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1639
Mailing Address - Country:US
Mailing Address - Phone:718-224-4932
Mailing Address - Fax:718-224-4932
Practice Address - Street 1:1635 BELL BLVD FL 1
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1639
Practice Address - Country:US
Practice Address - Phone:718-224-4932
Practice Address - Fax:718-224-4932
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist