MEDICARE: HAN DONG

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	AC00511	TX

General Provider Information

NPI Number	:	1518016468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAN DONG

Provider Business Mailing Address
First Line	:	11754 JOLLYVILLE RD
Second Line	:	SUITE 102
City	:	AUSTIN
State	:	TX
Zip	:	78759-2460
Country	:	US
Telephone Number	:	512-258-0488
Fax Number	:

Provider Business Practice Location Address
First Line	:	11754 JOLLYVILLE RD
Second Line	:	SUITE 102
City	:	AUSTIN
State	:	TX
Zip	:	78759-2460
Country	:	US
Telephone Number	:	512-258-0488
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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Directions to “ HAN DONG ” Practice Location

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