Healthcare Provider Details

I. General information

NPI: 1881776532
Provider Name (Legal Business Name): YUNXIA WANG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 GRAND CONCOURSE 2ND FLOOR
BRONX NY
10453-4929
US

IV. Provider business mailing address

7 WAINWRIGHT AVE APT 2B
YONKERS NY
10710-5843
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-5000
  • Fax: 718-294-6060
Mailing address:
  • Phone: 914-299-9663
  • Fax: 718-294-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001696-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: