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General NPI Number Information
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NPI Number | 1477720696
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Entity Type | Organization
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Legal Business Name | ROYAL ACUPUNCTURE & HERB CENTER
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 5105C BACKLICK RD
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City | ANNANDALE
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State | VA
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Zip | 22003-6005
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Country | US
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Telephone | 703-813-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 5105C BACKLICK RD
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City | ANNANDALE
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State | VA
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Zip | 22003-6005
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Country | US
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Telephone | 703-813-6009
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. CHANG HEE KIM
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Credential | LAC.
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Telephone | 703-813-6009
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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 | 0121000381
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License Number State | VA
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