Healthcare Provider Details

I. General information

NPI: 1164835807
Provider Name (Legal Business Name): ACUPUNCTURE & HERBS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
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

5730 BACKLICK RD APT 202
SPRINGFIELD VA
22150-3256
US

V. Phone/Fax

Practice location:
  • Phone: 571-287-1764
  • Fax:
Mailing address:
  • Phone: 703-989-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberAC500174
License Number StateDC

VIII. Authorized Official

Name: MR. THUONG PHU
Title or Position: ACUPUNCTURIST
Credential: L.AC.
Phone: 703-989-9711