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General NPI Number Information
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NPI Number | 1407384928
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Entity Type | Organization
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Legal Business Name | ANGIE NG, INC
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Dates
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Enumeration Date | 05/28/2017
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Last Update Date | 05/28/2017
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Provider Practice Location Address
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Address Line | 223 W JACKSON BLVD STE 860
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City | CHICAGO
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State | IL
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Zip | 60606-6908
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Country | US
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Telephone | 312-933-7856
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Fax |
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Provider Business Mailing Address
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Address Line | 1217 W AUGUSTA BLVD UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60642-4121
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Country | US
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Telephone | 312-933-7856
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | ANGIE NG
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Credential | L.AC.
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Telephone | 312-933-7856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 198000772
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License Number State | IL
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