Provider Demographics
NPI:1972011377
Name:CHENTILLY ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:CHENTILLY ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIYANG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:571-251-2631
Mailing Address - Street 1:43919 EASTGATE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-2599
Mailing Address - Country:US
Mailing Address - Phone:571-251-2631
Mailing Address - Fax:
Practice Address - Street 1:43919 EASTGATE VIEW DR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-2015
Practice Address - Country:US
Practice Address - Phone:571-251-2631
Practice Address - Fax:571-251-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000843261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center