Provider Demographics
NPI:1235791088
Name:POTOMAC ACUCLINIC LLC
Entity Type:Organization
Organization Name:POTOMAC ACUCLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD , LAC
Authorized Official - Phone:770-820-7163
Mailing Address - Street 1:10615 GREAT ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4220
Mailing Address - Country:US
Mailing Address - Phone:770-820-7163
Mailing Address - Fax:
Practice Address - Street 1:9800 FALLS RD STE 101
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3939
Practice Address - Country:US
Practice Address - Phone:240-802-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty