Provider Demographics
NPI:1760873178
Name:SHI, WENYAO (LAC)
Entity Type:Individual
Prefix:
First Name:WENYAO
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:7102 SEA CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5030
Mailing Address - Country:US
Mailing Address - Phone:571-969-2684
Mailing Address - Fax:703-893-8809
Practice Address - Street 1:7635 LEESBURG PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2520
Practice Address - Country:US
Practice Address - Phone:571-969-2684
Practice Address - Fax:703-893-8809
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-08
Last Update Date:2016-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0121000762171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist