Healthcare Provider Details

I. General information

NPI: 1174784680
Provider Name (Legal Business Name): HONGHUA CUI III OMD,LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5812 N LINCOLN AVE
CHICAGO IL
60659
US

IV. Provider business mailing address

5812 N LINCOLN AVE
CHICAGO IL
60659
US

V. Phone/Fax

Practice location:
  • Phone: 773-583-0011
  • Fax: 773-878-0011
Mailing address:
  • Phone: 773-583-0011
  • Fax: 773-878-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198-000156
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: