Provider Demographics
NPI:1063906378
Name:DODAM ACUPUNCTURE P.C
Entity type:Organization
Organization Name:DODAM ACUPUNCTURE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHANG JOON
Authorized Official - Middle Name:
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-563-5820
Mailing Address - Street 1:3622 PARSONS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5932
Mailing Address - Country:US
Mailing Address - Phone:917-563-5820
Mailing Address - Fax:917-563-5819
Practice Address - Street 1:6215 20TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3024
Practice Address - Country:US
Practice Address - Phone:917-563-5820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005242171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty