Provider Demographics
NPI:1093111494
Name:HOLY ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:HOLY ACUPUNCTURE LLC
Other - Org Name:HOLY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ACUPUNTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:301-448-7405
Mailing Address - Street 1:937 RUSSELL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3280
Mailing Address - Country:US
Mailing Address - Phone:301-448-7405
Mailing Address - Fax:240-246-0095
Practice Address - Street 1:937 RUSSELL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3280
Practice Address - Country:US
Practice Address - Phone:301-448-7405
Practice Address - Fax:240-246-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00751171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty