Provider Demographics
NPI:1407381858
Name:KYONG, MYOUNG J (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:MYOUNG
Middle Name:J
Last Name:KYONG
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 242ND ST UNIT 10C
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2082
Mailing Address - Country:US
Mailing Address - Phone:646-353-7857
Mailing Address - Fax:
Practice Address - Street 1:6601 242ND ST UNIT 10C
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2082
Practice Address - Country:US
Practice Address - Phone:646-353-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist