MEDICARE: LING KU 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	1165	HI

General Provider Information

NPI Number	:	1720526262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LING KU L.AC.

Provider Business Mailing Address
First Line	:	1401 S BERETANIA ST STE 300
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-1872
Country	:	US
Telephone Number	:	808-772-4219
Fax Number	:	808-200-1215

Provider Business Practice Location Address
First Line	:	1401 S BERETANIA ST STE 300
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-1872
Country	:	US
Telephone Number	:	808-772-4219
Fax Number	:	808-200-1215

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

Provider Enumeration Date	:	02/04/2017
Last Update Date	:	02/04/2017

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