Healthcare Provider Details

I. General information

NPI: 1487984084
Provider Name (Legal Business Name): JING HUANG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 WOODBROOK CT
CHARLOTTESVILLE VA
22901-1148
US

IV. Provider business mailing address

2013 WOODBROOK CT DR JING ACUPUNCTURE AND HERBS
CHARLOTTESVILLE VA
22901
US

V. Phone/Fax

Practice location:
  • Phone: 716-380-3580
  • Fax:
Mailing address:
  • Phone: 716-380-3580
  • Fax: 434-872-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000577
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: