MEDICARE: MS. SHANG HONG LIWONG

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	AP3910	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202256998	OTHER		ACUPUNCTURE
2	202256998	OTHER	FL	ACUPUNCTURE

General Provider Information

NPI Number	:	1871095505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANG HONG LIWONG

Provider Business Mailing Address
First Line	:	633 NE 167TH ST STE 1015
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2448
Country	:	US
Telephone Number	:	786-972-2416
Fax Number	:	754-263-3817

Provider Business Practice Location Address
First Line	:	633 NE 167TH ST STE 1015
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2448
Country	:	US
Telephone Number	:	786-972-2416
Fax Number	:

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

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	03/08/2018

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Directions to “ MS. SHANG HONG LIWONG ” Practice Location

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