=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578200861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA KWAI HOW YURONG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2022
-----------------------------------------------------
Last Update Date | 05/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6440 E BROADWAY BLVD
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85710-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-881-0827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8255 N ORACLE RD APT 202
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-6442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-230-0347
-----------------------------------------------------
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 | LAC-011379
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------