=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235759903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HANDS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2020
-----------------------------------------------------
Last Update Date | 01/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14087 RICHMOND HWY STE 101
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22191-2171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-300-8000
-----------------------------------------------------
Fax | 571-300-8001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1964 GALLOWS RD STE 300
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-3814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-712-7199
-----------------------------------------------------
Fax | 703-712-7015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | CONSTANTINE CHIENKU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 703-712-7199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------