Healthcare Provider Details

I. General information

NPI: 1699214023
Provider Name (Legal Business Name): J&K MEDICAL CENTER OF PALM BEACH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4047 OKEECHOBEE BLVD SUITE #113
WEST PALM BEACH FL
33409-3239
US

IV. Provider business mailing address

4047 OKEECHOBEE BLVD SUITE # 113
WEST PALM BEACH FL
33409-3239
US

V. Phone/Fax

Practice location:
  • Phone: 561-640-3986
  • Fax:
Mailing address:
  • Phone: 561-640-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1712
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1865
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3631
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP308
License Number StateFL

VIII. Authorized Official

Name: KEH-NAN FANG
Title or Position: VICE PRESIDENT
Credential:
Phone: 561-640-3986