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General NPI Number Information
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NPI Number | 1952687931
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Entity Type | Organization
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Legal Business Name | IVY CLINIC FOR ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC
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Dates
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Enumeration Date | 10/22/2011
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 100 N WASHINGTON ST SUITE 311
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4523
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Country | US
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Telephone | 339-223-6723
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Fax |
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Provider Business Mailing Address
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Address Line | 7209 HANSFORD CT
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3000
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Country | US
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Telephone | 339-223-6723
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MS. WEI HONG-REN
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Credential | LAC
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Telephone | 339-223-6723
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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 | 0121-000617
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License Number State | VA
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