Provider Demographics
NPI:1366911067
Name:HUANGPU, XING JUN (LAC, LMT)
Entity type:Individual
Prefix:
First Name:XING JUN
Middle Name:
Last Name:HUANGPU
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13621 ROOSEVELT AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5507
Mailing Address - Country:US
Mailing Address - Phone:929-855-0028
Mailing Address - Fax:
Practice Address - Street 1:13621 ROOSEVELT AVE STE 304
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5507
Practice Address - Country:US
Practice Address - Phone:929-855-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2022-11-30
Deactivation Date:2022-01-31
Deactivation Code:
Reactivation Date:2022-03-24
Provider Licenses
StateLicense IDTaxonomies
NY031402225700000X
NY006982171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist