Provider Demographics
NPI:1427646926
Name:KASIMCAN, MUSTAFA OMUR
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:OMUR
Last Name:KASIMCAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PARK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3303
Mailing Address - Country:US
Mailing Address - Phone:703-637-3626
Mailing Address - Fax:
Practice Address - Street 1:313 PARK AVE STE 203
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3303
Practice Address - Country:US
Practice Address - Phone:703-637-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2025-09-03
Deactivation Date:2021-06-09
Deactivation Code:
Reactivation Date:2025-09-03
Provider Licenses
StateLicense IDTaxonomies
VA0121001221171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty