Provider Demographics
NPI:1912314592
Name:DE GREGORIO, BOK NAM (LIC AC, MOM)
Entity type:Individual
Prefix:
First Name:BOK NAM
Middle Name:
Last Name:DE GREGORIO
Suffix:
Gender:F
Credentials:LIC AC, MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MARE TERRACE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-7700
Mailing Address - Country:US
Mailing Address - Phone:703-798-3874
Mailing Address - Fax:
Practice Address - Street 1:55 MARE TERRACE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-0287
Practice Address - Country:US
Practice Address - Phone:703-798-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
RIDA00477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist