Provider Demographics
NPI:1164060026
Name:AOM CLINIC LLC
Entity Type:Organization
Organization Name:AOM CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RIM
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, LAC
Authorized Official - Phone:571-287-1764
Mailing Address - Street 1:7535 LITTLE RIVER TPKE STE 103A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2983
Mailing Address - Country:US
Mailing Address - Phone:571-287-1764
Mailing Address - Fax:888-276-6354
Practice Address - Street 1:7535 LITTLE RIVER TPKE STE 103A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2983
Practice Address - Country:US
Practice Address - Phone:571-287-1764
Practice Address - Fax:888-276-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA19009773OtherSTATE MASSAGE LICENSE
DCAC500174OtherSTATE ACUPUNCTURE LICENSE
VA0121000474OtherSTATE ACUPUNCTURE LICENSE
VA0121000929OtherSTATE ACUPUNCTURE LICENSE