Provider Demographics
NPI:1760935084
Name:NOVA TRAINING CENTER CLINIC
Entity Type:Organization
Organization Name:NOVA TRAINING CENTER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:DAE HYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-203-5666
Mailing Address - Street 1:14701 LEE HWY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2137
Mailing Address - Country:US
Mailing Address - Phone:703-266-2220
Mailing Address - Fax:
Practice Address - Street 1:14701 LEE HWY
Practice Address - Street 2:SUITE 306
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2137
Practice Address - Country:US
Practice Address - Phone:703-266-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000779171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty