Healthcare Provider Details

I. General information

NPI: 1952629115
Provider Name (Legal Business Name): PAZIONG ACUPUNCTURE CLINIC OF WOODBURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 WOODLANE DR
WOODBURY MN
55125-2221
US

IV. Provider business mailing address

1520 WOODLANE DR
WOODBURY MN
55125-2221
US

V. Phone/Fax

Practice location:
  • Phone: 651-210-9657
  • Fax:
Mailing address:
  • Phone: 651-210-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1403
License Number StateMN

VIII. Authorized Official

Name: MRS. PAZIONG ESTELLE LO-VANG
Title or Position: OWNER
Credential: L.AC.
Phone: 651-214-5657