1780820084 NPI number — MR. YONG FU SHAO LAC

Table of content: MR. YONG FU SHAO LAC (NPI 1780820084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780820084 NPI number — MR. YONG FU SHAO LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAO
Provider First Name:
YONG
Provider Middle Name:
FU
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAO
Provider Other First Name:
YONG
Provider Other Middle Name:
FU
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780820084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11094 LEE HWY
Provider Second Line Business Mailing Address:
D101
Provider Business Mailing Address City Name:
FAIRFAX CITY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-209-8599
Provider Business Mailing Address Fax Number:
703-802-0858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11094 LEE HWY
Provider Second Line Business Practice Location Address:
D101
Provider Business Practice Location Address City Name:
FAIRFAX CITY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-209-8599
Provider Business Practice Location Address Fax Number:
703-802-0858
Provider Enumeration Date:
12/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0121-000098 . This is a "VIRGINIA BOARD OF MEDICINE ISSUED" identifier . This identifiers is of the category "OTHER".




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