Provider Demographics
NPI:1770972150
Name:VIRGINIA UNIVERSITY OF ORIENTAL MEDICINE
Entity type:Organization
Organization Name:VIRGINIA UNIVERSITY OF ORIENTAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, PHD, LAC
Authorized Official - Phone:703-323-5691
Mailing Address - Street 1:9401 MATHY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5312
Mailing Address - Country:US
Mailing Address - Phone:703-323-5691
Mailing Address - Fax:703-323-5692
Practice Address - Street 1:9401 MATHY DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5312
Practice Address - Country:US
Practice Address - Phone:703-323-5691
Practice Address - Fax:703-323-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000381302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization