Healthcare Provider Details

I. General information

NPI: 1932585163
Provider Name (Legal Business Name): GOLDEN CHIRO ACUPUNCTURE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10195 MAIN ST SUITE F
FAIRFAX VA
22031-3415
US

IV. Provider business mailing address

10195 MAIN ST SUITE F
FAIRFAX VA
22031-3415
US

V. Phone/Fax

Practice location:
  • Phone: 703-277-9897
  • Fax:
Mailing address:
  • Phone: 703-277-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number0104556491
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000759
License Number StateVA

VIII. Authorized Official

Name: DR. KEVIN H KIM
Title or Position: MGR
Credential: DC, LAC
Phone: 703-277-9897