MEDICARE: LONG PHAM 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	MAP418	SC

General Provider Information

NPI Number	:	1790525400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONG PHAM L.AC.

Provider Business Mailing Address
First Line	:	1608 CAMP RD # 91
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-4012
Country	:	US
Telephone Number	:	843-608-1091
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 LANNEAU LN
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8276
Country	:	US
Telephone Number	:	843-608-1091
Fax Number	:

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

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	02/20/2026

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Directions to “ LONG PHAM L.AC.” Practice Location

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