MEDICARE: WEIWEI GONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1326742354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WEIWEI GONG

Provider Business Mailing Address
First Line	:	4306 VIA DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10329 DEMOCRACY LN STE B
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2559
Country	:	US
Telephone Number	:	703-682-2197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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Directions to “ WEIWEI GONG ” Practice Location

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