Provider Demographics
NPI:1598296378
Name:DONGBANG ACCUPUNCTURE, CORP
Entity Type:Organization
Organization Name:DONGBANG ACCUPUNCTURE, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:MR
Authorized Official - First Name:JIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-445-4370
Mailing Address - Street 1:3518 150TH PL
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4922
Mailing Address - Country:US
Mailing Address - Phone:718-445-4370
Mailing Address - Fax:718-445-4378
Practice Address - Street 1:3518 150TH PL
Practice Address - Street 2:SUITE 1C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4922
Practice Address - Country:US
Practice Address - Phone:718-445-4370
Practice Address - Fax:718-445-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2521-01261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center