Provider Demographics
NPI:1801535406
Name:JIN, XUELONG (LAC)
Entity type:Individual
Prefix:
First Name:XUELONG
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 FAIRFAX BLVD APT 2426
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2444
Mailing Address - Country:US
Mailing Address - Phone:929-218-3822
Mailing Address - Fax:
Practice Address - Street 1:14631 LEE HWY STE 115
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5825
Practice Address - Country:US
Practice Address - Phone:929-218-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist