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General NPI Number Information
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NPI Number | 1457895757
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Entity Type | Organization
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Legal Business Name | DONG YO ACUPUNCTURE
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 2105 PALM BAY RD NE STE 2
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City | PALM BAY
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State | FL
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Zip | 32905-2937
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Country | US
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Telephone | 321-723-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 PALM BAY RD NE STE 2
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City | PALM BAY
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State | FL
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Zip | 32905-2937
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Country | US
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Telephone | 321-723-3017
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | SUSAN JEAN HATHAWAY
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Credential | DAOM
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Telephone | 321-723-3017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | AC164809
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP1352
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License Number State | FL
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