MEDICARE: YUAN WAN

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	000342	NY

General Provider Information

NPI Number	:	1487737987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUAN WAN

Provider Business Mailing Address
First Line	:	11049 63RD DR
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1407
Country	:	US
Telephone Number	:	212-594-4811
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 5TH AVE
Second Line	:	SUITE1822
City	:	NEW YORK
State	:	NY
Zip	:	10118-0110
Country	:	US
Telephone Number	:	212-594-4811
Fax Number	:	121-259-4358

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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Directions to “ YUAN WAN ” Practice Location

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