Healthcare Provider Details

I. General information

NPI: 1124589114
Provider Name (Legal Business Name): HONG KUAI L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROUTE 146 STE 276
CLIFTON PARK NY
12065-3905
US

IV. Provider business mailing address

67 WILLOWBROOK TER
HALFMOON NY
12065-2647
US

V. Phone/Fax

Practice location:
  • Phone: 518-488-7579
  • Fax:
Mailing address:
  • Phone: 518-488-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: