Healthcare Provider Details

I. General information

NPI: 1821738394
Provider Name (Legal Business Name): KATHY NIU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 FRANKLIN CORNER RD
LAWRENCEVILLE NJ
08648-2586
US

IV. Provider business mailing address

136 FRANKLIN CORNER RD
LAWRENCEVILLE NJ
08648-2586
US

V. Phone/Fax

Practice location:
  • Phone: 609-912-0440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00159100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: