Provider Demographics
NPI:1053768598
Name:KE JIN'S ACUPUNCTURE & HERBAL CLINIC
Entity type:Organization
Organization Name:KE JIN'S ACUPUNCTURE & HERBAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:
Authorized Official - First Name:KE
Authorized Official - Middle Name:
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:732-823-7219
Mailing Address - Street 1:275 E MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3210
Mailing Address - Country:US
Mailing Address - Phone:732-823-7219
Mailing Address - Fax:
Practice Address - Street 1:1187 MAIN AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2252
Practice Address - Country:US
Practice Address - Phone:732-823-7219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-14
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00071100171100000X
NJ25MZ00108600171100000X
NJ25MZ00104000171100000X
NJ25MZ00106400171100000X
NJ25MZ00110700171100000X
NJ25MZ00122100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty