Provider Demographics
NPI:1710388780
Name:YOO, WANG YOUNG (DIPL OM, LAC, PHD)
Entity Type:Individual
Prefix:
First Name:WANG
Middle Name:YOUNG
Last Name:YOO
Suffix:
Gender:M
Credentials:DIPL OM, LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14641 LEE HWY STE D6
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5819
Mailing Address - Country:US
Mailing Address - Phone:703-625-7116
Mailing Address - Fax:703-263-3174
Practice Address - Street 1:14641 LEE HWY STE D6
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5819
Practice Address - Country:US
Practice Address - Phone:703-625-7116
Practice Address - Fax:703-815-8502
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02064171100000X
VA0121-000725171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist