Provider Demographics
NPI:1205055985
Name:GENG, YUAN (LAC)
Entity type:Individual
Prefix:MR
First Name:YUAN
Middle Name:
Last Name:GENG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 MAIN ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4741
Mailing Address - Country:US
Mailing Address - Phone:718-321-3368
Mailing Address - Fax:
Practice Address - Street 1:4260 MAIN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4741
Practice Address - Country:US
Practice Address - Phone:718-321-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist