Healthcare Provider Details

I. General information

NPI: 1194203026
Provider Name (Legal Business Name): MRS. JING CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 CARLISLE DR STE A
HERNDON VA
20170-4895
US

IV. Provider business mailing address

3257 TAYLOE CT
HERNDON VA
20171-3370
US

V. Phone/Fax

Practice location:
  • Phone: 571-307-7266
  • Fax: 703-880-7146
Mailing address:
  • Phone: 571-305-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000879
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: