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General NPI Number Information
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NPI Number | 1932499407
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Entity Type | Organization
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Legal Business Name | SPORTS EDGE ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 1033 STERLING RD STE 105
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City | HERNDON
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State | VA
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Zip | 20170-3837
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Country | US
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Telephone | 571-306-0533
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Fax | 703-537-0229
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Provider Business Mailing Address
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Address Line | 1033 STERLING RD STE 105
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City | HERNDON
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State | VA
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Zip | 20170-3837
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Country | US
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Telephone | 571-306-0533
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Fax | 703-537-0229
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Authorized Official
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Title or Position | OWNER
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Name | DR. HON LEE
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Credential | L.AC., DAOM
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Telephone | 571-306-0533
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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 | 0121000348
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License Number State | VA
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