Healthcare Provider Details

I. General information

NPI: 1710165675
Provider Name (Legal Business Name): DIANA L. OKADA M.S., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2008
Last Update Date: 02/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 57TH ST SUITE 520
NEW YORK NY
10019-2303
US

IV. Provider business mailing address

7814 AUSTIN ST 6D
FOREST HILLS NY
11375-6152
US

V. Phone/Fax

Practice location:
  • Phone: 917-902-4825
  • Fax:
Mailing address:
  • Phone: 917-902-4825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: