Provider Demographics
NPI:1891170171
Name:PK WELLNESS, LLC
Entity Type:Organization
Organization Name:PK WELLNESS, LLC
Other - Org Name:PK ACUPUNCTURE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:512-650-8880
Mailing Address - Street 1:1011 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4931
Mailing Address - Country:US
Mailing Address - Phone:512-650-8880
Mailing Address - Fax:
Practice Address - Street 1:1011 W 11TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4931
Practice Address - Country:US
Practice Address - Phone:512-650-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty