=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073470829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLLY INTEGRATED MEDICINE,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9520A ROUTE 29
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-232-4976
-----------------------------------------------------
Fax | 703-297-8179
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8883 OLIVE MAE CIR
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-1479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-232-4976
-----------------------------------------------------
Fax | 703-297-8179
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | HAOYUN WANG
-----------------------------------------------------
Credential | OM
-----------------------------------------------------
Telephone | 571-232-4976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------