Provider Demographics
NPI:1366052664
Name:SHALOM EASTERN MEDICINE,INC
Entity type:Organization
Organization Name:SHALOM EASTERN MEDICINE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:301-814-1211
Mailing Address - Street 1:3344 SAINT JOHNS LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2601
Mailing Address - Country:US
Mailing Address - Phone:301-814-1211
Mailing Address - Fax:240-720-4900
Practice Address - Street 1:3344 SAINT JOHNS LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2601
Practice Address - Country:US
Practice Address - Phone:301-814-1211
Practice Address - Fax:240-720-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty