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General NPI Number Information
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NPI Number | 1376840264
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Entity Type | Organization
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Legal Business Name | PAN GOO INC.
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 1225 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32803-4701
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Country | US
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Telephone | 321-795-0373
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32803-4701
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Country | US
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Telephone | 321-795-0373
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS YA-SUI LIN
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Credential | AP,D.O.M
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Telephone | 321-795-0373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2371
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License Number State | FL
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