Provider Demographics
NPI:1780820084
Name:SHAO, YONG FU (LAC)
Entity Type:Individual
Prefix:MR
First Name:YONG
Middle Name:FU
Last Name:SHAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:YONG
Other - Middle Name:FU
Other - Last Name:SHAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11094 LEE HWY
Mailing Address - Street 2:D101
Mailing Address - City:FAIRFAX CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-209-8599
Mailing Address - Fax:703-802-0858
Practice Address - Street 1:11094 LEE HWY
Practice Address - Street 2:D101
Practice Address - City:FAIRFAX CITY
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-209-8599
Practice Address - Fax:703-802-0858
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0121-000098OtherVIRGINIA BOARD OF MEDICINE ISSUED