Healthcare Provider Details

I. General information

NPI: 1245777531
Provider Name (Legal Business Name): TING LUNG L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 220
SALT LAKE CITY UT
84107-8603
US

IV. Provider business mailing address

4516 S 700 E STE 220
SALT LAKE CITY UT
84107-8603
US

V. Phone/Fax

Practice location:
  • Phone: 801-290-2106
  • Fax:
Mailing address:
  • Phone: 801-290-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12238883-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: