=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295071561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESSENCE OF ACUPUNCTURE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2012
-----------------------------------------------------
Last Update Date | 12/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2273 KINGS GARDEN WAY
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-426-2195
-----------------------------------------------------
Fax | 703-821-1264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2273 KINGS GARDEN WAY
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-426-2195
-----------------------------------------------------
Fax | 703-821-1264
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. I-HSIN TAMMY CHANG
-----------------------------------------------------
Credential | LIC. AC.
-----------------------------------------------------
Telephone | 571-426-2195
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | U01968
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 0121000675
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------