Healthcare Provider Details

I. General information

NPI: 1992039655
Provider Name (Legal Business Name): SHU FAN ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 I ST NW STE 410
WASHINGTON DC
20006-3746
US

IV. Provider business mailing address

7106 NORWALK ST
FALLS CHURCH VA
22043-1517
US

V. Phone/Fax

Practice location:
  • Phone: 703-772-7592
  • Fax:
Mailing address:
  • Phone: 703-772-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC500100
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: