Healthcare Provider Details

I. General information

NPI: 1720525637
Provider Name (Legal Business Name): LAON ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CONGERS RD FL 1
NEW CITY NY
10956-5135
US

IV. Provider business mailing address

37 CONGERS RD FL 1
NEW CITY NY
10956-5135
US

V. Phone/Fax

Practice location:
  • Phone: 929-777-5220
  • Fax:
Mailing address:
  • Phone: 929-777-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5537
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL KIM
Title or Position: PRESIDENT
Credential: L.AC.
Phone: 631-375-0306