MEDICARE: YAN SONG

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	006595	NY

General Provider Information

NPI Number	:	1053952325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAN SONG

Provider Business Mailing Address
First Line	:	13705 FRANKLIN AVE APT 4S
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-3803
Country	:	US
Telephone Number	:	347-755-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 W 169TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-2914
Country	:	US
Telephone Number	:	516-739-1545
Fax Number	:

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/08/2019

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Directions to “ YAN SONG ” Practice Location

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