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General NPI Number Information
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NPI Number | 1265791131
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Entity Type | Individual
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Provider Name | BRIAN P WAH LAC
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Gender | Male
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/26/2012
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Provider Practice Location Address
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Address Line | 443 CARLISLE DR STE B
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City | HERNDON
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State | VA
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Zip | 20170-5623
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Country | US
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Telephone | 703-867-6323
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Fax |
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Provider Business Mailing Address
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Address Line | 13227 PLEASANTVIEW LN
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City | FAIRFAX
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State | VA
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Zip | 22033-3015
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Country | US
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Telephone | 703-867-6323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0121-000669
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U01956
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License Number State | MD
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