Healthcare Provider Details

I. General information

NPI: 1053261396
Provider Name (Legal Business Name): EUN-KYUNG ANNA KIM LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 BOONE BLVD STE 170
VIENNA VA
22182-2621
US

IV. Provider business mailing address

26098 NIMBLETON SQ
CHANTILLY VA
20152-3661
US

V. Phone/Fax

Practice location:
  • Phone: 703-825-7130
  • Fax:
Mailing address:
  • Phone: 410-627-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2000071
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03188
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number01210001249
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: