Provider Demographics
NPI:1578355251
Name:PROCARE WELLNESS MCLEAN
Entity type:Organization
Organization Name:PROCARE WELLNESS MCLEAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:PUKAI
Authorized Official - Middle Name:
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:571-207-6789
Mailing Address - Street 1:6888 ELM ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3829
Mailing Address - Country:US
Mailing Address - Phone:571-207-6789
Mailing Address - Fax:
Practice Address - Street 1:6888 ELM ST STE 2A
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3829
Practice Address - Country:US
Practice Address - Phone:571-207-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center