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General NPI Number Information
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NPI Number | 1235791088
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Entity Type | Organization
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Legal Business Name | POTOMAC ACUCLINIC LLC
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 9800 FALLS RD STE 101
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City | POTOMAC
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State | MD
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Zip | 20854-3939
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Country | US
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Telephone | 240-802-0025
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Fax |
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Provider Business Mailing Address
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Address Line | 10615 GREAT ARBOR DR
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City | POTOMAC
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State | MD
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Zip | 20854-4220
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Country | US
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Telephone | 770-820-7163
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEUNG J PARK
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Credential | PH.D , L.AC
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Telephone | 770-820-7163
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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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