Provider Demographics
NPI:1578200861
Name:YURONG, ALICIA KWAI HOW
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:KWAI HOW
Last Name:YURONG
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 1:8255 N ORACLE RD APT 202
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6442
Mailing Address - Country:US
Mailing Address - Phone:808-230-0347
Mailing Address - Fax:
Practice Address - Street 1:6440 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3504
Practice Address - Country:US
Practice Address - Phone:520-881-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-011379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA