Healthcare Provider Details

I. General information

NPI: 1477341154
Provider Name (Legal Business Name): CORE INTEGRATIVE CARE & WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14153 ROBERT PARIS CT STE A
CHANTILLY VA
20151-4225
US

IV. Provider business mailing address

14153 ROBERT PARIS CT STE A
CHANTILLY VA
20151-4225
US

V. Phone/Fax

Practice location:
  • Phone: 703-865-6455
  • Fax: 36-496-4557
Mailing address:
  • Phone: 703-865-6455
  • Fax: 703-649-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN WOOGI KIM
Title or Position: PRESIDENT
Credential: DPT
Phone: 703-865-6455