Provider Demographics
NPI:1871095505
Name:LIWONG, SHANG HONG
Entity type:Individual
Prefix:MS
First Name:SHANG HONG
Middle Name:
Last Name:LIWONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 NE 167TH ST STE 1015
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2448
Mailing Address - Country:US
Mailing Address - Phone:786-972-2416
Mailing Address - Fax:754-263-3817
Practice Address - Street 1:633 NE 167TH ST STE 1015
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2448
Practice Address - Country:US
Practice Address - Phone:786-972-2416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3910171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
202256998OtherACUPUNCTURE
FL202256998OtherACUPUNCTURE