Healthcare Provider Details

I. General information

NPI: 1285016840
Provider Name (Legal Business Name): RUN HONG TANG HERBAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 AVENUE U
BROOKLYN NY
11229
US

IV. Provider business mailing address

1720 AVENUE U
BROOKLYN NY
11229-3812
US

V. Phone/Fax

Practice location:
  • Phone: 646-641-8529
  • Fax:
Mailing address:
  • Phone: 164-654-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002333
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number021994
License Number StateNY

VIII. Authorized Official

Name: DR. RUN HONG LI
Title or Position: EMPLOYER
Credential: DR
Phone: 646-541-8529