Provider Demographics
NPI:1851632251
Name:SU, MING (M OF ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:MING
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:M OF ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 CHESTER VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1797
Mailing Address - Country:US
Mailing Address - Phone:804-318-0128
Mailing Address - Fax:
Practice Address - Street 1:3601 W HUNDRED RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1901
Practice Address - Country:US
Practice Address - Phone:804-318-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000645171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist