Most Relevant Information
Provider Data
| NPI Number: | 1003450636 |
| Provider Name: | TAEJEAN CONVERTI DOM, MSOM, LAC |
| Entity Type: | Individual |
| Taxonomy Code: | 171100000X |
| Specialty: | Acupuncturist |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/06/2019 |
| Last Updated: | 10/03/2020 |
Provider Practice Location
8909 DAY LILLY CT
FAIRFAX
VA
220311464
Practice Location Phone/Fax
| Phone: | 7038643636 |
| Fax: |
Provider Mailing Location
8909 DAY LILLY CT
FAIRFAX
VA
220311464
Provider Mailing Phone/Fax
| Phone: | 7038643636 |
| Fax: |