MEDICARE: LOHAS ACUPUNCTURE AND HERBS LLC

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	005031	NY
2	171100000X	Acupuncturist	25MZ00098300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750624128	OTHER	NJ	ACUPUNCTURE

General Provider Information

NPI Number	:	1255844569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOHAS ACUPUNCTURE AND HERBS LLC

Provider Business Mailing Address
First Line	:	1579 PALISADE AVE FL 2
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6931
Country	:	US
Telephone Number	:	201-815-7070
Fax Number	:	201-585-7070

Provider Business Practice Location Address
First Line	:	1579 PALISADE AVE FL 2
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6931
Country	:	US
Telephone Number	:	201-815-7070
Fax Number	:	201-585-7070

Authorized Official
Title or Position	:	PARTNER, LICENSED ACUPUNCTURIST
Name	:	KATHLEEN JIYUN LEE
Credential	:	L.AC
Telephone Number	:	201-815-7070

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	11/08/2017

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