MEDICARE: BALANCE ACUPUNCTURE & WELLNESS CENTER LLC

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

General Provider Information

NPI Number	:	1538715131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE ACUPUNCTURE & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	3454 ELLICOTT CENTER DR STE 104
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4130
Country	:	US
Telephone Number	:	410-465-8012
Fax Number	:

Provider Business Practice Location Address
First Line	:	3454 ELLICOTT CENTER DR STE 104
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4130
Country	:	US
Telephone Number	:	410-465-8012
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	MR. SANG KWON HONG
Credential	:	LAC
Telephone Number	:	443-812-0857

Provider Enumeration Date	:	08/11/2019
Last Update Date	:	08/11/2019

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