Healthcare Provider Details

I. General information

NPI: 1023355997
Provider Name (Legal Business Name): ALEXANDRA KHOURI L. AC,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 OLD COURTHOUSE RD SUITE 220
VIENNA VA
22182-3822
US

IV. Provider business mailing address

8300 OLD COURTHOUSE RD SUITE 220
VIENNA VA
22182-3822
US

V. Phone/Fax

Practice location:
  • Phone: 703-254-9599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000611
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: