Organization
LIFETREE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYU HONG TAE L.AC. (OWNER)
(612) 723-2042
Entity
Organization
Contact information
Practice address
14585 GRAND AVE, SUITE 206, BURNSVILLE, MN 55306-5719
(952) 435-7349
(952) 417-6159
Mailing address
14585 GRAND AVE, SUITE 206, BURNSVILLE, MN 55306-5719
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
1529
MN
364SA2200X
Adult Health Clinical Nurse Specialist
0082
MN
Other
Enumeration date
04/20/2012
Last updated
04/17/2018
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