Provider Demographics
NPI:1649472622
Name:HUANG, BO (LAC)
Entity type:Individual
Prefix:MR
First Name:BO
Middle Name:
Last Name:HUANG
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 1:2129 63RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3059
Mailing Address - Country:US
Mailing Address - Phone:718-236-9881
Mailing Address - Fax:
Practice Address - Street 1:109 LAFAYETTE ST
Practice Address - Street 2:SUITE 807
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4154
Practice Address - Country:US
Practice Address - Phone:212-625-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000665171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP644076OtherOXFORD
NY009411OtherEMPIRE