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General NPI Number Information
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NPI Number | 1396171005
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Entity Type | Individual
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Provider Name | DONGXING SUN LAC
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Gender | Male
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 03/07/2021
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Provider Practice Location Address
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Address Line | 9229 QUEENS BLVD APT 14G
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City | REGO PARK
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State | NY
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Zip | 11374-1061
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Country | US
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Telephone | 917-821-6275
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Fax |
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Provider Business Mailing Address
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Address Line | 9229 QUEENS BLVD APT 14G
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City | REGO PARK
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State | NY
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Zip | 11374-1061
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Country | US
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Telephone | 917-821-6275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 001106
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License Number State | NY
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