MEDICARE: MR. STEVEN YONG JI LAC

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	006192	NY

General Provider Information

NPI Number	:	1124663448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN YONG JI LAC

Provider Business Mailing Address
First Line	:	18 TEXAS CT
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-3123
Country	:	US
Telephone Number	:	718-216-8688
Fax Number	:

Provider Business Practice Location Address
First Line	:	2488 GRAND CONCOURSE RM 206
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5207
Country	:	US
Telephone Number	:	718-216-8688
Fax Number	:

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

Provider Enumeration Date	:	11/11/2019
Last Update Date	:	11/11/2019

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