1952687931 NPI number — IVY CLINIC FOR ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC

Table of content: (NPI 1952687931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952687931 NPI number — IVY CLINIC FOR ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IVY CLINIC FOR ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1952687931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7209 HANSFORD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22151-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
339-223-6723
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22046-4523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
339-223-6723
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HONG-REN
Authorized Official First Name:
WEI
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
339-223-6723

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  0121-000617 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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