Provider Demographics
NPI:1487340881
Name:KPDI ACUPUNCTURE, PLLC
Entity type:Organization
Organization Name:KPDI ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:IACOVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-380-1021
Mailing Address - Street 1:5145 DUKE STREET
Mailing Address - Street 2:SUITE D, BOX 101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:503-380-1021
Mailing Address - Fax:
Practice Address - Street 1:714 N JORDAN ST APT 301
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-6843
Practice Address - Country:US
Practice Address - Phone:503-380-1021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty