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General NPI Number Information
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NPI Number | 1508237405
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Entity Type | Organization
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Legal Business Name | BEIJING RAPHA
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Dates
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Enumeration Date | 10/18/2015
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Last Update Date | 10/18/2015
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Provider Practice Location Address
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Address Line | 573 SOUTHLAKE BLVD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3095
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Country | US
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Telephone | 804-833-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 573 SOUTHLAKE BLVD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3095
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Country | US
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Telephone | 804-833-1062
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HYUNGGYU KANG
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Credential | LAC
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Telephone | 804-833-1062
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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 | VA0121000691
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License Number State | VA
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