MEDICARE: MRS. KWANGHEE LYEW 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	005692	NY

General Provider Information

NPI Number	:	1306361589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KWANGHEE LYEW LAC.

Provider Business Mailing Address
First Line	:	245 N BROADWAY STE 206
Second Line	:
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2657
Country	:	US
Telephone Number	:	914-522-0536
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 N BROADWAY STE 206
Second Line	:
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2657
Country	:	US
Telephone Number	:	914-522-0536
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	07/21/2022

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