=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124503784
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAI FUNG NGAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2018
-----------------------------------------------------
Last Update Date | 09/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7216 ROOSEVELT AVE # 2R
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-6335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-808-8033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8757 17TH AVE FL 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11214-4546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-925-8884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 006085
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------