Provider Demographics
NPI:1417555178
Name:BETHESDA ACUPUNCTURE WELLNESS CLINIC INC.
Entity Type:Organization
Organization Name:BETHESDA ACUPUNCTURE WELLNESS CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:301-717-0789
Mailing Address - Street 1:1803 RESEARCH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3155
Mailing Address - Country:US
Mailing Address - Phone:301-717-0789
Mailing Address - Fax:
Practice Address - Street 1:1803 RESEARCH BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3155
Practice Address - Country:US
Practice Address - Phone:301-717-0789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty