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General NPI Number Information
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NPI Number | 1750436192
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Entity Type | Individual
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Provider Name | TAO GONG L.AC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6545 FRANCE AVE S # C-21
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City | EDINA
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State | MN
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Zip | 55435-2131
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Country | US
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Telephone | 952-922-5000
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Fax | 952-922-5003
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Provider Business Mailing Address
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Address Line | 5717 KEMRICH DR
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City | EDINA
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State | MN
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Zip | 55439-1813
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Country | US
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Telephone | 952-828-9888
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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 | 1348
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License Number State | MN
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