Healthcare Provider Details

I. General information

NPI: 1003872557
Provider Name (Legal Business Name): YNGE LJUNG AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 NE 45TH ST SUITE # 202
FT LAUDERDALE FL
33308-5199
US

IV. Provider business mailing address

1915 NE 45TH ST SUITE # 202
FT LAUDERDALE FL
33308-5199
US

V. Phone/Fax

Practice location:
  • Phone: 954-667-6637
  • Fax: 954-667-6629
Mailing address:
  • Phone: 954-667-6637
  • Fax: 954-667-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: