MEDICARE: DONGBANG ACCUPUNCTURE, CORP

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	261Q00000X	Clinic/Center	2521-01	NY

General Provider Information

NPI Number	:	1598296378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONGBANG ACCUPUNCTURE, CORP

Provider Business Mailing Address
First Line	:	3518 150TH PL
Second Line	:	SUITE 1C
City	:	FLUSHING
State	:	NY
Zip	:	11354-4922
Country	:	US
Telephone Number	:	718-445-4370
Fax Number	:	718-445-4378

Provider Business Practice Location Address
First Line	:	3518 150TH PL
Second Line	:	SUITE 1C
City	:	FLUSHING
State	:	NY
Zip	:	11354-4922
Country	:	US
Telephone Number	:	718-445-4370
Fax Number	:	718-445-4378

Authorized Official
Title or Position	:	LAC
Name	:	MR. JIANA XU
Credential	:
Telephone Number	:	718-445-4370

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	03/23/2017

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