MEDICARE: BETWEEN HEAVEN AND EARTH

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	AP650	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP650	OTHER	FL	ACUPUNCTURE

General Provider Information

NPI Number	:	1700151073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETWEEN HEAVEN AND EARTH

Provider Business Mailing Address
First Line	:	1915 NE 45TH ST
Second Line	:	STE 202
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5199
Country	:	US
Telephone Number	:	954-667-6637
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 NE 45TH ST
Second Line	:	STE 202
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5199
Country	:	US
Telephone Number	:	954-667-6637
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. YNGE LJUNG
Credential	:	AP
Telephone Number	:	954-667-6637

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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Directions to “BETWEEN HEAVEN AND EARTH ” Practice Location

Language	Start Address	Practice Location

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