Healthcare Provider Details

I. General information

NPI: 1760346415
Provider Name (Legal Business Name): RONGJUANYING DENG LAC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 DOBIE RD STE 255
OKEMOS MI
48864-2233
US

IV. Provider business mailing address

4655 DOBIE RD STE 255
OKEMOS MI
48864-2233
US

V. Phone/Fax

Practice location:
  • Phone: 272-336-4722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5402000318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: