Healthcare Provider Details

I. General information

NPI: 1164060026
Provider Name (Legal Business Name): AOM CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 LITTLE RIVER TPKE STE 103A
ANNANDALE VA
22003-2983
US

IV. Provider business mailing address

7535 LITTLE RIVER TPKE STE 103A
ANNANDALE VA
22003-2983
US

V. Phone/Fax

Practice location:
  • Phone: 571-287-1764
  • Fax: 888-276-6354
Mailing address:
  • Phone: 571-287-1764
  • Fax: 888-276-6354

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: DR. TAE Y RIM
Title or Position: PRESIDENT AND CLINIC DIRECTOR
Credential: DAOM, L.AC.
Phone: 571-287-1764