Provider Demographics
NPI:1679256879
Name:HAMASAKI, MIO (DOM, LAC)
Entity Type:Individual
Prefix:
First Name:MIO
Middle Name:
Last Name:HAMASAKI
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:MIO
Other - Middle Name:
Other - Last Name:HARADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9667 MAIN ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9667 MAIN ST.
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-672-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist