Basic Information
| Provider Information | |||||||||
| NPI: | 1821643560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LI | ||||||||
| FirstName: | HONGYU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1051 58TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112194427 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 56TH ST APT 1 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112204197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122198987 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 006258 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.