=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114485869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YUNG HWA ASIAN HEALING ARTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2019
-----------------------------------------------------
Last Update Date | 03/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5718 WOODSIDE AVE STE B102
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-3444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-426-7900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6044 83RD ST
-----------------------------------------------------
City | MIDDLE VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11379-5444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | VERA YUNG
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 917-541-7897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------