Provider Demographics
NPI:1427277102
Name:KUNG, MARY (LAC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PURCHASE ST
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2141
Mailing Address - Country:US
Mailing Address - Phone:914-967-1834
Mailing Address - Fax:914-967-2780
Practice Address - Street 1:150 PURCHASE ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2141
Practice Address - Country:US
Practice Address - Phone:914-967-1834
Practice Address - Fax:914-967-2780
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
NY000162171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist