Provider Demographics
NPI:1558004564
Name:MAO, JUSTIN (LAC ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:MAO
Suffix:
Gender:M
Credentials:LAC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2235
Mailing Address - Country:US
Mailing Address - Phone:703-362-5895
Mailing Address - Fax:
Practice Address - Street 1:1008 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2235
Practice Address - Country:US
Practice Address - Phone:703-362-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECT-0010008171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty