Provider Demographics
NPI:1699135772
Name:EXTRAORDINARY VESSELS TRADITIONAL ACUPUNCTURE
Entity type:Organization
Organization Name:EXTRAORDINARY VESSELS TRADITIONAL ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:AMARAL
Authorized Official - Last Name:KORANGY
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC
Authorized Official - Phone:410-980-1397
Mailing Address - Street 1:1233 DIETRICH WAY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5020
Mailing Address - Country:US
Mailing Address - Phone:410-980-1397
Mailing Address - Fax:
Practice Address - Street 1:1233 DIETRICH WAY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5020
Practice Address - Country:US
Practice Address - Phone:410-980-1397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00484261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service