Healthcare Provider Details

I. General information

NPI: 1912848573
Provider Name (Legal Business Name): KIM TAN ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 ANNAPOLIS RD STE 304
LANHAM MD
20706-3168
US

IV. Provider business mailing address

9332 ANNAPOLIS RD STE 304
LANHAM MD
20706-3168
US

V. Phone/Fax

Practice location:
  • Phone: 571-464-2236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: QUANG VU
Title or Position: OWNER
Credential:
Phone: 415-864-9541