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General NPI Number Information
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NPI Number | 1003260860
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Entity Type | Organization
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Legal Business Name | YEDAM WELL-BEING CENTER INC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 4600 JOHN MARR DR STE 402
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City | ANNANDALE
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State | VA
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Zip | 22003-3310
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Country | US
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Telephone | 703-942-8858
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 JOHN MARR DR STE 402
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City | ANNANDALE
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State | VA
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Zip | 22003-3310
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | HOYOON CHONG
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Credential |
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Telephone | 703-942-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0121000632
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License Number State | VA
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