Provider Demographics
NPI:1467905646
Name:SERENE EARTH ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:SERENE EARTH ACUPUNCTURE, LLC
Other - Org Name:LANI WONG, M.AC., LIC.AC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LANI
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LICAC
Authorized Official - Phone:781-366-0881
Mailing Address - Street 1:47 3RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1265
Mailing Address - Country:US
Mailing Address - Phone:781-366-0881
Mailing Address - Fax:
Practice Address - Street 1:12 BOSTON ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-7721
Practice Address - Country:US
Practice Address - Phone:781-366-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty