Healthcare Provider Details

I. General information

NPI: 1366911067
Provider Name (Legal Business Name): XING JUN HUANGPU L.AC., LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date: 01/31/2022
Reactivation Date: 03/24/2022

III. Provider practice location address

13621 ROOSEVELT AVE STE 304
FLUSHING NY
11354-5507
US

IV. Provider business mailing address

13621 ROOSEVELT AVE STE 304
FLUSHING NY
11354-5507
US

V. Phone/Fax

Practice location:
  • Phone: 929-855-0028
  • Fax:
Mailing address:
  • Phone: 929-855-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number031402
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006982
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: