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General NPI Number Information
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NPI Number | 1902548662
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Entity Type | Individual
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Provider Name | SUK JA AN LICMASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 8109 HINSON FARM RD STE 515
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3427
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Country | US
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Telephone | 703-765-7275
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Fax |
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Provider Business Mailing Address
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Address Line | 10350 LURIA COMMONS CT # 3G
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City | BURKE
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State | VA
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Zip | 22015-2824
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Country | US
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Telephone | 703-989-1933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019018547
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License Number State | VA
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