Provider Demographics
NPI:1124526181
Name:MIRACLE HEALING ACUPUNCTURE
Entity type:Organization
Organization Name:MIRACLE HEALING ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIPL. AC., DAC.
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DAC
Authorized Official - Phone:443-303-6946
Mailing Address - Street 1:5006 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6719
Mailing Address - Country:US
Mailing Address - Phone:516-851-7601
Mailing Address - Fax:
Practice Address - Street 1:5052 DORSEY HALL DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7750
Practice Address - Country:US
Practice Address - Phone:443-303-6946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02470261QH0100X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02470OtherSTATE LICENSE