MEDICARE: MR. DUC TUNG LY 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	AC01089	OR

General Provider Information

NPI Number	:	1255534954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUC TUNG LY L.AC.

Provider Business Mailing Address
First Line	:	140 HIGH ST APT 2
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2641
Country	:	US
Telephone Number	:	541-890-6046
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 SISKIYOU BLVD
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2400
Country	:	US
Telephone Number	:	541-488-9696
Fax Number	:	541-552-9684

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/08/2007

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