Healthcare Provider Details

I. General information

NPI: 1881001071
Provider Name (Legal Business Name): THUONG PHU L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2014
Last Update Date: 07/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CONNECTICUT AVE NW # 135N
WASHINGTON DC
20008-2509
US

IV. Provider business mailing address

5730 BACKLICK RD APT 202
SPRINGFIELD VA
22150-3256
US

V. Phone/Fax

Practice location:
  • Phone: 703-989-9711
  • Fax:
Mailing address:
  • Phone: 703-989-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC500174
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: