Ildong Im, L.AC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

25MZ00036100 Issued in NJ

Practice address

120 Van Nostrand Ave
Englewood Cliffs, NJ 07632-1555

Phone

(204) 944-5999

NPI assigned

Jul 8, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1183852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548468853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 PEARL RD",
            "city": "CLOSTER",
            "state": "NJ",
            "postal_code": "076241621",
            "telephone_number": "201-750-2671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 VAN NOSTRAND AVE",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076321555",
            "telephone_number": "204-944-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IM",
        "first_name": "ILDONG",
        "credential": "L.AC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NJ",
            "license": "25MZ00036100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Englewood Cliffs, NJ
• Providers in Englewood Cliffs, NJ by specialty
• Acupuncturist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.