=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881001071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THUONG PHU L.AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2014
-----------------------------------------------------
Last Update Date | 07/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 CONNECTICUT AVE NW # 135N
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20008-2509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-989-9711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5730 BACKLICK RD APT 202
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22150-3256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-989-9711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC500174
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------