Provider Demographics
NPI:1760751820
Name:WONG, MOON HUNG (LAC)
Entity Type:Individual
Prefix:MR
First Name:MOON
Middle Name:HUNG
Last Name:WONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6604 GRAND CENTRAL PKWY
Mailing Address - Street 2:APT. 2A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1938
Mailing Address - Country:US
Mailing Address - Phone:646-733-8180
Mailing Address - Fax:516-599-0185
Practice Address - Street 1:6604 GRAND CENTRAL PKWY
Practice Address - Street 2:APT. 2A
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1938
Practice Address - Country:US
Practice Address - Phone:646-733-8180
Practice Address - Fax:516-599-0185
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist