Healthcare Provider Details

I. General information

NPI: 1982912697
Provider Name (Legal Business Name): DYNASTY ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23938 66TH AVE
LITTLE NECK NY
11362-1923
US

IV. Provider business mailing address

23938 66TH AVE
LITTLE NECK NY
11362-1923
US

V. Phone/Fax

Practice location:
  • Phone: 917-385-1567
  • Fax:
Mailing address:
  • Phone: 917-385-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001607
License Number StateNY

VIII. Authorized Official

Name: DR. ZHI YUAN ZHONG
Title or Position: PRESIDENT
Credential: LAC
Phone: 917-385-1567