Organization
GEUNJAE CLINIC LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANG YOUNG YOO .L.AC. DIPL.OM (DIRECTOR)
(703) 625-7116
Entity
Organization
Contact information
Practice address
14641 LEE HWY, STE D-6, CENTREVILLE, VA 20121-2112
(703) 625-7116
Mailing address
14641 LEE HWY, D-6, CENTREVILLE, VA 20121-2112
(703) 625-7116
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
0121000725
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0121000725
L.AC
VA
Enumeration date
10/27/2016
Last updated
10/27/2016
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