Provider Demographics
NPI:1366016826
Name:MEDICINE HAND
Entity Type:Organization
Organization Name:MEDICINE HAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT
Authorized Official - Prefix:
Authorized Official - First Name:JONGMYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-733-3119
Mailing Address - Street 1:13566 PLUMBAGO DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7004 LITTLE RIVER TPKE STE B
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3201
Practice Address - Country:US
Practice Address - Phone:410-733-3119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty