=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780054288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PING TRADTIONAL CHINESE MEDICINE,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2015
-----------------------------------------------------
Last Update Date | 09/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1920 E NC HIGHWAY 54 SUITE 620
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-2293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-491-8983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1920 E NC HIGHWAY 54 SUITE 620
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-2293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-491-8983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORGANIZER
-----------------------------------------------------
Name | PING HE
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 919-491-8983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------