MEDICARE: YOUNG JI ACUPUNCTURE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1710453808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG JI ACUPUNCTURE CLINIC

Provider Business Mailing Address
First Line	:	12921 OLD COLUMBIA PIKE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-5225
Country	:	US
Telephone Number	:	703-505-7387
Fax Number	:

Provider Business Practice Location Address
First Line	:	3459 SAINT JOHNS LN STE 9
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4026
Country	:	US
Telephone Number	:	703-505-7387
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YOUNG AE JI
Credential	:	PHD
Telephone Number	:	703-505-7387

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	10/16/2018

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