Healthcare Provider Details

I. General information

NPI: 1124526181
Provider Name (Legal Business Name): MIRACLE HEALING ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5052 DORSEY HALL DR
ELLICOTT CITY MD
21042-7750
US

IV. Provider business mailing address

5006 MONTGOMERY RD
ELLICOTT CITY MD
21043-6719
US

V. Phone/Fax

Practice location:
  • Phone: 443-303-6946
  • Fax:
Mailing address:
  • Phone: 516-851-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberU02470
License Number StateMD

VIII. Authorized Official

Name: DR. HENRY KIM
Title or Position: DIPL. AC., DAC.
Credential: DAC.
Phone: 443-303-6946