Provider Demographics
NPI:1881212991
Name:RENEWED ORIENTAL MEDICINE CLINIC, INC.
Entity Type:Organization
Organization Name:RENEWED ORIENTAL MEDICINE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:WANSOO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:703-577-0639
Mailing Address - Street 1:9685 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3752
Mailing Address - Country:US
Mailing Address - Phone:703-577-0639
Mailing Address - Fax:
Practice Address - Street 1:9685 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3752
Practice Address - Country:US
Practice Address - Phone:703-577-0639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center