MEDICARE: HEEWON PAE LAC.

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	198000554	IL

General Provider Information

NPI Number	:	1710431820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEEWON PAE LAC.

Provider Business Mailing Address
First Line	:	1720 MILWAUKEE AVE
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-1441
Country	:	US
Telephone Number	:	224-305-1588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1576 N WINDSOR DR
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4100
Country	:	US
Telephone Number	:	224-305-1588
Fax Number	:

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

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	08/05/2016

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Directions to “ HEEWON PAE LAC.” Practice Location

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