Provider Demographics
NPI:1194734418
Name:SANGWOO MAH, D.C., P.C.
Entity type:Organization
Organization Name:SANGWOO MAH, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGWOO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-746-4919
Mailing Address - Street 1:15001 NORTHERN BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3846
Mailing Address - Country:US
Mailing Address - Phone:718-746-4919
Mailing Address - Fax:718-746-4920
Practice Address - Street 1:15001 NORTHERN BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3846
Practice Address - Country:US
Practice Address - Phone:718-746-4919
Practice Address - Fax:718-746-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
06436GMedicare ID - Type Unspecified