Healthcare Provider Details

I. General information

NPI: 1205566684
Provider Name (Legal Business Name): HOLISTIC ACUPUNCTURE AT MCLEAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 DOLLEY MADISON BLVD STE 204
MC LEAN VA
22101-3926
US

IV. Provider business mailing address

1313 DOLLEY MADISON BLVD STE 204
MC LEAN VA
22101-3926
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-7773
  • Fax: 571-248-7773
Mailing address:
  • Phone: 571-248-7773
  • Fax: 571-248-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: YUESHAN HU
Title or Position: MEMBER
Credential:
Phone: 605-691-9957