MEDICARE: ZEN WELLNESS CENTER LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1124496484	OTHER		ACUPUNCTURE

General Provider Information

NPI Number	:	1497260129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZEN WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	249 PHILADELPHIA PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-3109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	249 PHILADELPHIA PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-3109
Country	:	US
Telephone Number	:	302-559-1325
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONGKYU SONG
Credential	:	L.AC. DAOM
Telephone Number	:	302-559-1325

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	12/04/2017

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Directions to “ZEN WELLNESS CENTER LLC ” Practice Location

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