Healthcare Provider Details

I. General information

NPI: 1760299820
Provider Name (Legal Business Name): HEALTHQI ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HIGHWAY 169 N STE 103
NEW HOPE MN
55428-4032
US

IV. Provider business mailing address

4900 HIGHWAY 169 N STE 103
NEW HOPE MN
55428-4032
US

V. Phone/Fax

Practice location:
  • Phone: 612-412-4490
  • Fax:
Mailing address:
  • Phone: 612-412-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: PUN CHANG
Title or Position: OWNER/ACUPUNCTURIST
Credential: LAC
Phone: 612-412-4490