MEDICARE: MR. LIWU LIN L.AC.

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	006081	NY

General Provider Information

NPI Number	:	1578021614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LIWU LIN L.AC.

Provider Business Mailing Address
First Line	:	13668 ROOSEVELT AVE, ROOM 802
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-1234
Country	:	US
Telephone Number	:	929-375-7802
Fax Number	:	929-577-4746

Provider Business Practice Location Address
First Line	:	13249 41ST RD STE C1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-4286
Country	:	US
Telephone Number	:	929-375-7802
Fax Number	:	929-577-4767

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

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	06/21/2023

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