Healthcare Provider Details

I. General information

NPI: 1346549557
Provider Name (Legal Business Name): OSUN TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16486 KRAMER ESTATE DR.
WOODBRIDGE VA
22191
US

IV. Provider business mailing address

16486 KRAMER ESTATE DR.
WOODBRIDGE VA
22191
US

V. Phone/Fax

Practice location:
  • Phone: 703-878-2568
  • Fax:
Mailing address:
  • Phone: 703-878-2568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: WANDA ZHAO RUSSELL
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 703-878-2568