Provider Demographics
NPI:1609081587
Name:HAWKES, HAIYAN SHI (LAC,, CMD)
Entity Type:Individual
Prefix:MS
First Name:HAIYAN
Middle Name:SHI
Last Name:HAWKES
Suffix:
Gender:F
Credentials:LAC,, CMD
Other - Prefix:MS
Other - First Name:HAIYAN
Other - Middle Name:SHI
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, CMD
Mailing Address - Street 1:16220 FREDERICK RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:240-654-1240
Mailing Address - Fax:
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:SUITE 404
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:240-654-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01258171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist