Provider Demographics
NPI:1407384928
Name:ANGIE NG, INC
Entity Type:Organization
Organization Name:ANGIE NG, INC
Other - Org Name:ACUPUNCTURE FOR BALANCED WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:312-933-7856
Mailing Address - Street 1:1217 W AUGUSTA BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-4121
Mailing Address - Country:US
Mailing Address - Phone:312-933-7856
Mailing Address - Fax:
Practice Address - Street 1:223 W JACKSON BLVD STE 860
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6908
Practice Address - Country:US
Practice Address - Phone:312-933-7856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-28
Last Update Date:2017-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000772261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center