Provider Demographics
NPI:1790062107
Name:ACADEMY OF ACUPUNCTURE & CHINESE MEDICINE, LLC
Entity Type:Organization
Organization Name:ACADEMY OF ACUPUNCTURE & CHINESE MEDICINE, LLC
Other - Org Name:WILDWOOD ACUPUNCTURE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:XIAOMING
Authorized Official - Middle Name:
Authorized Official - Last Name:TIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:301-530-5308
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 418
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-530-5308
Mailing Address - Fax:301-564-5808
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 418
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-530-5308
Practice Address - Fax:301-564-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU214171100000X
MDU01837171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty