Provider Demographics
NPI:1255689931
Name:UENO, TETSUHIRO (LAC)
Entity Type:Individual
Prefix:
First Name:TETSUHIRO
Middle Name:
Last Name:UENO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 EISENHOWER AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4695
Mailing Address - Country:US
Mailing Address - Phone:703-717-9088
Mailing Address - Fax:703-717-9158
Practice Address - Street 1:2111 EISENHOWER AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4695
Practice Address - Country:US
Practice Address - Phone:703-717-9088
Practice Address - Fax:703-717-9158
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist