Provider Demographics
NPI:1790540706
Name:LAN, FLORA FENG (L AC)
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:FENG
Last Name:LAN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 GLENGYLE DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5519
Mailing Address - Country:US
Mailing Address - Phone:571-686-1427
Mailing Address - Fax:
Practice Address - Street 1:1751 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:TYSONS
Practice Address - State:VA
Practice Address - Zip Code:22102-4903
Practice Address - Country:US
Practice Address - Phone:571-686-1427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist