Healthcare Provider Details

I. General information

NPI: 1073196507
Provider Name (Legal Business Name): CAOLIACCUPUNCTURE.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 DEFENSE HWY STE 103
GAMBRILLS MD
21054-2021
US

IV. Provider business mailing address

2568 LOG MILL CT
CROFTON MD
21114-1861
US

V. Phone/Fax

Practice location:
  • Phone: 443-527-1095
  • Fax:
Mailing address:
  • Phone: 202-290-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: KEWEI CAO
Title or Position: OWNER
Credential:
Phone: 202-290-8535