Healthcare Provider Details

I. General information

NPI: 1164728390
Provider Name (Legal Business Name): KING LING YEUNG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2011
Last Update Date: 02/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BAY 26TH ST
BROOKLYN NY
11214-4905
US

IV. Provider business mailing address

211 BAY 26TH ST
BROOKLYN NY
11214-4905
US

V. Phone/Fax

Practice location:
  • Phone: 347-387-4249
  • Fax:
Mailing address:
  • Phone: 347-387-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004159
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: