Provider Demographics
NPI:1255484622
Name:LONG, MIAN (L AC)
Entity Type:Individual
Prefix:DR
First Name:MIAN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2169 MOTT-SMITH DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2564
Mailing Address - Country:US
Mailing Address - Phone:808-599-1870
Mailing Address - Fax:402-817-3684
Practice Address - Street 1:651 ILALO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5525
Practice Address - Country:US
Practice Address - Phone:808-692-0908
Practice Address - Fax:808-692-1958
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 722171100000X
NY1049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist