Healthcare Provider Details

I. General information

NPI: 1992398663
Provider Name (Legal Business Name): WIN BILL HUANG LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2021
Last Update Date: 02/14/2021
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5813 6TH AVE # 2B
BROOKLYN NY
11220-3808
US

IV. Provider business mailing address

5813 6TH AVE # 2B
BROOKLYN NY
11220-3808
US

V. Phone/Fax

Practice location:
  • Phone: 347-262-9184
  • Fax:
Mailing address:
  • Phone: 347-262-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: