MEDICARE: DOMINIC CONG UONG L.AC.

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	AC01193	TX

General Provider Information

NPI Number	:	1699092650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC CONG UONG L.AC.

Provider Business Mailing Address
First Line	:	2687 BRADLEY LN
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-4595
Country	:	US
Telephone Number	:	281-902-2315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2013 WELLS BRANCH PKWY
Second Line	:	SUITE 103
City	:	AUSTIN
State	:	TX
Zip	:	78728-6900
Country	:	US
Telephone Number	:	512-835-6077
Fax Number	:

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

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	09/27/2010

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