Healthcare Provider Details

I. General information

NPI: 1578355251
Provider Name (Legal Business Name): PROCARE WELLNESS MCLEAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6888 ELM ST STE 2A
MC LEAN VA
22101-3829
US

IV. Provider business mailing address

6888 ELM ST STE 2A
MC LEAN VA
22101-3829
US

V. Phone/Fax

Practice location:
  • Phone: 571-207-6789
  • Fax:
Mailing address:
  • Phone: 571-207-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PUKAI JIN
Title or Position: ACUPUNCTURIST
Credential: DOM
Phone: 571-207-6789