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General NPI Number Information
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NPI Number | 1902075161
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Entity Type | Organization
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Legal Business Name | WAN SHIN MD PC
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-776-6086
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Fax | 703-776-6085
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Provider Business Mailing Address
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Address Line | PO BOX 7446
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-7446
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Country | US
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Telephone | 703-776-6086
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Fax | 703-776-6085
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAN SHIN
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Credential | M.D.
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Telephone | 703-776-6086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101030663
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License Number State | VA
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