Individual
MR. JAEWAN SO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
424 2ND AVE W, EAST NORTHPORT, NY 11731-3401
(631) 368-2359
Mailing address
424 2ND AVE W, EAST NORTHPORT, NY 11731-3401
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
004508
NY
Other
Enumeration date
03/10/2011
Last updated
03/10/2011
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