Provider Demographics
NPI:1225998420
Name:KOOK, JACQUELINE (LAC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KOOK
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 1:218 W 113TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3361
Mailing Address - Country:US
Mailing Address - Phone:917-526-1003
Mailing Address - Fax:
Practice Address - Street 1:252 W 38TH ST RM 406
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5178
Practice Address - Country:US
Practice Address - Phone:646-543-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist