MEDICARE: MS. LIQUN YANG LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	000651	NY

General Provider Information

NPI Number	:	1174521223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIQUN YANG LAC

Provider Business Mailing Address
First Line	:	8703 JUSTICE AVE
Second Line	:	SUITE 1E
City	:	ELMHURST
State	:	NY
Zip	:	11373-4556
Country	:	US
Telephone Number	:	718-424-7869
Fax Number	:

Provider Business Practice Location Address
First Line	:	8703 JUSTICE AVE
Second Line	:	SUITE 1E
City	:	ELMHURST
State	:	NY
Zip	:	11373-4556
Country	:	US
Telephone Number	:	718-424-7869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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