MEDICARE: WONGU HEALTH CENTER

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	:	1588315741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONGU HEALTH CENTER

Provider Business Mailing Address
First Line	:	8630 S EASTERN AVE # NV
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2836
Country	:	US
Telephone Number	:	702-852-1280
Fax Number	:	702-551-0411

Provider Business Practice Location Address
First Line	:	8630 S EASTERN AVE # NV
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2836
Country	:	US
Telephone Number	:	702-852-1280
Fax Number	:	702-551-0411

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANGHYUN LEE
Credential	:	OMD, L.AC
Telephone Number	:	702-852-1280

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	09/15/2022

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Directions to “WONGU HEALTH CENTER ” Practice Location

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