Lifetree Clinic

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

1529 Issued in MN

Legal business name

LIFETREE CLINIC

Practice address

14585 Grand Ave
Suite 206
Burnsville, MN 55306-5719

Phone

(952) 435-7349

Fax

(952) 417-6159

NPI assigned

Apr 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyu Hong Tae, L.AC.NPI 1811213168

Title

Owner

Phone

(612) 723-2042

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyu Hong Tae

  • Acupuncturist
  • Burnsville, MN
  • NPI 1811213168
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1972860526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14585 GRAND AVE",
            "address_2": "SUITE 206",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553065719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14585 GRAND AVE",
            "address_2": "SUITE 206",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553065719",
            "telephone_number": "952-435-7349",
            "fax_number": "952-417-6159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3101 Old Highway 8 Ste 104",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "MN",
            "postal_code": "551131069",
            "country_code": "US",
            "telephone_number": "952-435-7349",
            "fax_number": "952-417-6159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFETREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-20",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "TAE",
        "authorized_official_first_name": "KYU HONG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-723-2042",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "MN",
            "license": "1529",
            "primary": true
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "MN",
            "license": "0082",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Acupuncturist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.