Provider Demographics
NPI:1740785104
Name:HEALING TAO ACUPUNCTURE CENTER, LLC
Entity Type:Organization
Organization Name:HEALING TAO ACUPUNCTURE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:301-379-2516
Mailing Address - Street 1:6540 ARLINGTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-6638
Mailing Address - Country:US
Mailing Address - Phone:301-960-8887
Mailing Address - Fax:
Practice Address - Street 1:6540 ARLINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-6638
Practice Address - Country:US
Practice Address - Phone:301-960-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000210171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0121000210OtherVA BOARD OF MEDICINE