Healthcare Provider Details

I. General information

NPI: 1588941934
Provider Name (Legal Business Name): INTERNATIONAL NATURA CLINIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 LITTLE RIVER TPKE STE 102A
ANNANDALE VA
22003-2400
US

IV. Provider business mailing address

7700 LITTLE RIVER TPKE STE 102A
ANNANDALE VA
22003-2400
US

V. Phone/Fax

Practice location:
  • Phone: 703-752-4623
  • Fax: 703-762-9978
Mailing address:
  • Phone: 703-752-4623
  • Fax: 703-762-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556453
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000474
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1588941934
License Number StateVA

VIII. Authorized Official

Name: SUN HEE LEE
Title or Position: OWNER
Credential:
Phone: 571-287-1764