Healthcare Provider Details

I. General information

NPI: 1720556350
Provider Name (Legal Business Name): JINRU ZHU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11931 GEORGIA AVE
SILVER SPRING MD
20902-2001
US

IV. Provider business mailing address

3 APPLEGRATH CT
GERMANTOWN MD
20876-5613
US

V. Phone/Fax

Practice location:
  • Phone: 301-962-8988
  • Fax:
Mailing address:
  • Phone: 301-580-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM05989
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT2224
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC500278
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: