=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750134326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TING YU FENG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2024
-----------------------------------------------------
Last Update Date | 04/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 LIDO BLVD
-----------------------------------------------------
City | LAKE GROVE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11755-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-951-0663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 LIDO BLVD
-----------------------------------------------------
City | LAKE GROVE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11755-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-951-0663
-----------------------------------------------------
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 | 007471
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------