=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720350093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMC ALEXANDRIA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2012
-----------------------------------------------------
Last Update Date | 02/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4613 PINECREST OFFICE PARK DR STE C
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22312-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-302-0134
-----------------------------------------------------
Fax | 703-354-3577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4613 PINECREST OFFICE PARK DR STE C
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22312-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-302-0134
-----------------------------------------------------
Fax | 703-354-3577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JADELYNN KUM HEO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-354-3380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 0121000412
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------