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General NPI Number Information
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NPI Number | 1982160529
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Entity Type | Individual
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Provider Name | MAI CHONG YANG LAC.
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Gender | Female
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 832 CARMICHAEL RD
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City | HUDSON
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State | WI
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Zip | 54016-7759
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Country | US
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Telephone | 715-303-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 VILLA WAY APT 358
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City | EDINA
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State | MN
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Zip | 55436-2150
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Country | US
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Telephone | 715-302-4226
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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 | 961-55
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License Number State | WI
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