MEDICARE: LING HUA PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1710210059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LING HUA PA-C

Provider Business Mailing Address
First Line	:	540 W BRIAR PL
Second Line	:	APT 2N
City	:	CHICAGO
State	:	IL
Zip	:	60657-4661
Country	:	US
Telephone Number	:	617-407-8076
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 W BRIAR PL
Second Line	:	APT 2N
City	:	CHICAGO
State	:	IL
Zip	:	60657-4661
Country	:	US
Telephone Number	:	617-407-8076
Fax Number	:

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

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	10/08/2012

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Directions to “ LING HUA PA-C” Practice Location

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