MEDICARE: QIN QIONG GONG 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	AC00569	TX

General Provider Information

NPI Number	:	1407086499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QIN QIONG GONG L.AC.

Provider Business Mailing Address
First Line	:	2539 S GESSNER RD
Second Line	:	SUITE 25
City	:	HOUSTON
State	:	TX
Zip	:	77063-2034
Country	:	US
Telephone Number	:	713-922-8179
Fax Number	:	281-497-2082

Provider Business Practice Location Address
First Line	:	2539 S GESSNER RD
Second Line	:	SUITE 25
City	:	HOUSTON
State	:	TX
Zip	:	77063-2034
Country	:	US
Telephone Number	:	713-922-8179
Fax Number	:	281-497-2082

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

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	07/23/2009

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