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General NPI Number Information
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NPI Number | 1720567613
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Entity Type | Individual
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Provider Name | MIAE SON LAC
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Gender | Female
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 253-02 W END DR,
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City | LITTLE NECK
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State | NY
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Zip | 11362-1174
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Country | US
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Telephone | 646-267-9332
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Fax |
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Provider Business Mailing Address
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Address Line | 55 WINDMILL CT
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-1942
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Country | US
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Telephone | 646-267-9332
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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 | 00611
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License Number State | NY
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