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General NPI Number Information
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NPI Number | 1386548287
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Entity Type | Organization
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Legal Business Name | MOON ACUPUNCTURE AND HERB CLINIC, LLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 14631 ROUTE 29 STE B115
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City | CENTREVILLE
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State | VA
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Zip | 20121-5824
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Country | US
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Telephone | 301-458-0734
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Fax |
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Provider Business Mailing Address
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Address Line | 4393 POPLAR TREE CT
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City | CHANTILLY
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State | VA
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Zip | 20151-2523
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Country | US
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Telephone | 301-458-0734
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Fax |
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Authorized Official
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Title or Position | MEMBER-MANAGED
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Name | MIKYOUNG KIM
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Credential | L.AC
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Telephone | 301-458-0734
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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 | NULL
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