Healthcare Provider Details

I. General information

NPI: 1730857582
Provider Name (Legal Business Name): LYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 09/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 HUNGERFORD DR STE 15A
ROCKVILLE MD
20850-1743
US

IV. Provider business mailing address

966 HUNGERFORD DR STE 15A
ROCKVILLE MD
20850-1743
US

V. Phone/Fax

Practice location:
  • Phone: 240-779-7182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: YUHUA XIE
Title or Position: REPRESENTATIVE
Credential:
Phone: 240-779-7182