Provider Demographics
NPI:1255534954
Name:LY, DUC TUNG (LAC)
Entity type:Individual
Prefix:MR
First Name:DUC
Middle Name:TUNG
Last Name:LY
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 1:140 HIGH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2641
Mailing Address - Country:US
Mailing Address - Phone:541-890-6046
Mailing Address - Fax:
Practice Address - Street 1:1605 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2400
Practice Address - Country:US
Practice Address - Phone:541-488-9696
Practice Address - Fax:541-552-9684
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01089171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist