MEDICARE: GREAT LOONG 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	:	1578499000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LOONG LLC

Provider Business Mailing Address
First Line	:	1005 14TH AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-3629
Country	:	US
Telephone Number	:	808-259-1866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 14TH AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-3629
Country	:	US
Telephone Number	:	808-259-1866
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	VICTOR TAN
Credential	:	L,AC
Telephone Number	:	808-259-1866

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “GREAT LOONG LLC ” Practice Location

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