MEDICARE: MR. ANDREW YU SONG L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1194	MN

General Provider Information

NPI Number	:	1013193051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW YU SONG L.AC.

Provider Business Mailing Address
First Line	:	5851 DULUTH ST STE 317
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-3957
Country	:	US
Telephone Number	:	716-546-9188
Fax Number	:

Provider Business Practice Location Address
First Line	:	5851 DULUTH ST STE 317
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-3957
Country	:	US
Telephone Number	:	716-546-9188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2008
Last Update Date	:	01/19/2008

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