MEDICARE: EAST POINT MD LLC

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	U02116	MD

General Provider Information

NPI Number	:	1780198945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST POINT MD LLC

Provider Business Mailing Address
First Line	:	11924 PARKLAND CT
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213A CORPORATE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2247
Country	:	US
Telephone Number	:	703-727-9366
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SEONG MIN OUM
Credential	:
Telephone Number	:	703-727-9366

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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Directions to “EAST POINT MD LLC ” Practice Location

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