Healthcare Provider Details

I. General information

NPI: 1073818068
Provider Name (Legal Business Name): ZHENG HUANG L.AC, DIPL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 S WENTWORTH AVE UNIT B 18
CHICAGO IL
60616-2024
US

IV. Provider business mailing address

2002 S WENTWORTH AVE UNIT B 18
CHICAGO IL
60616-2024
US

V. Phone/Fax

Practice location:
  • Phone: 773-312-1924
  • Fax:
Mailing address:
  • Phone: 773-312-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.000897
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: