Healthcare Provider Details

I. General information

NPI: 1508773847
Provider Name (Legal Business Name): THEACUELAN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10090 MAIN ST STE 104
FAIRFAX VA
22031-3412
US

IV. Provider business mailing address

10090 MAIN ST STE 104
FAIRFAX VA
22031-3412
US

V. Phone/Fax

Practice location:
  • Phone: 703-401-1442
  • Fax:
Mailing address:
  • Phone: 703-401-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: THE NGOC NGUYEN
Title or Position: ACUPUNTURIST
Credential: DOM, LAC
Phone: 703-401-1442