MEDICARE: MARY KUNG 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	000162	NY

General Provider Information

NPI Number	:	1427277102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KUNG L.AC

Provider Business Mailing Address
First Line	:	150 PURCHASE ST
Second Line	:	SUITE 1-A
City	:	RYE
State	:	NY
Zip	:	10580-2141
Country	:	US
Telephone Number	:	914-967-1834
Fax Number	:	914-967-2780

Provider Business Practice Location Address
First Line	:	150 PURCHASE ST
Second Line	:	SUITE 1-A
City	:	RYE
State	:	NY
Zip	:	10580-2141
Country	:	US
Telephone Number	:	914-967-1834
Fax Number	:	914-967-2780

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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