Healthcare Provider Details

I. General information

NPI: 1659431815
Provider Name (Legal Business Name): YU HUANG LIC AC, MAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CLARKE ST STE 16
LEXINGTON MA
02421-4938
US

IV. Provider business mailing address

51 HILL RD APT 406
BELMONT MA
02478-4312
US

V. Phone/Fax

Practice location:
  • Phone: 617-359-7126
  • Fax: 617-484-1994
Mailing address:
  • Phone: 617-359-7126
  • Fax: 617-484-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number210999
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: