Healthcare Provider Details

I. General information

NPI: 1083417562
Provider Name (Legal Business Name): MILK IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 BOONE BLVD STE 630
VIENNA VA
22182-3894
US

IV. Provider business mailing address

5221 CONCORDIA ST
FAIRFAX VA
22032-3409
US

V. Phone/Fax

Practice location:
  • Phone: 703-372-9711
  • Fax:
Mailing address:
  • Phone: 661-202-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LACI TANG
Title or Position: OWNER
Credential:
Phone: 661-202-7545