Bravo Dallas Wellness Center LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC01575 Issued in TX

Legal business name

BRAVO DALLAS WELLNESS CENTER LLC

Practice address

4712 Dexter Dr Ste 100
Plano, TX 75093-5291

Phone

(201) 937-1551

NPI assigned

Oct 13, 2014

Last updated

Oct 13, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sung Mun Jung

Title

Owner

Phone

(201) 937-1551

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1225432701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4712 DEXTER DR STE 100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935291",
            "telephone_number": "201-937-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4712 DEXTER DR STE 100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935291",
            "telephone_number": "201-937-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVO DALLAS WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "SUNG",
        "authorized_official_middle_name": "MUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-937-1551"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "TX",
            "license": "AC01575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.