Provider Demographics
NPI:1619050788
Name:XU, HONG SU (LICACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:HONG
Middle Name:SU
Last Name:XU
Suffix:
Gender:F
Credentials:LICACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LORRAINE PL
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2807
Mailing Address - Country:US
Mailing Address - Phone:914-713-4206
Mailing Address - Fax:
Practice Address - Street 1:1130 PELHAM PKWY S APT 1C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1020
Practice Address - Country:US
Practice Address - Phone:718-863-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000299171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist