Provider Demographics
NPI:1679089957
Name:SEOUL ACUPUNCTURE CLINIC LLC
Entity type:Organization
Organization Name:SEOUL ACUPUNCTURE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SANGGOO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-815-1870
Mailing Address - Street 1:13880 BRADDOCK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2460
Mailing Address - Country:US
Mailing Address - Phone:703-815-1870
Mailing Address - Fax:
Practice Address - Street 1:13880 BRADDOCK RD STE 105
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2460
Practice Address - Country:US
Practice Address - Phone:703-815-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain