Provider Demographics
NPI:1821632225
Name:CAPITAL CENTER FOR ACUPUNCTURE & INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:CAPITAL CENTER FOR ACUPUNCTURE & INTEGRATIVE MEDICINE, LLC
Other - Org Name:BETHESDA ACUPUNCTURE & WELLNESS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-880-3232
Mailing Address - Street 1:6410 ROCKLEDGE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1841
Mailing Address - Country:US
Mailing Address - Phone:301-880-3232
Mailing Address - Fax:
Practice Address - Street 1:6410 ROCKLEDGE DR STE 310
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1841
Practice Address - Country:US
Practice Address - Phone:301-880-3232
Practice Address - Fax:301-530-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174826432OtherTYPE 1 INDIVIDUAL NPI
1821632225OtherTYPE 2 ORGANIZATION NPI
MDU01837OtherMARYLAND STATE LICENSE REGISTRATION NUMBER