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General NPI Number Information
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NPI Number | 1023825999
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Entity Type | Organization
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Legal Business Name | REVIVAL ACUPUNCTURE CLINIC LLC
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Dates
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Enumeration Date | 12/14/2024
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 9685 MAIN ST STE C
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City | FAIRFAX
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State | VA
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Zip | 22031-3752
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Country | US
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Telephone | 301-747-5336
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Fax |
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Provider Business Mailing Address
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Address Line | 4277 SLEEPY LAKE DR
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City | FAIRFAX
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State | VA
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Zip | 22033-2864
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Country | US
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Telephone | 301-747-5336
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | RHEA KIM
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Credential | L.AC
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Telephone | 571-301-9661
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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 |
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License Number State |
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