Provider Demographics
NPI:1508613241
Name:KEMPER, AMY SOO (LAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SOO
Last Name:KEMPER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HARRY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3152
Mailing Address - Country:US
Mailing Address - Phone:848-221-0109
Mailing Address - Fax:
Practice Address - Street 1:87 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:NJ
Practice Address - Zip Code:07934
Practice Address - Country:US
Practice Address - Phone:646-801-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00171300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist