Provider Demographics
NPI:1992039655
Name:FAN, SHU (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:SHU
Middle Name:
Last Name:FAN
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 NORWALK ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1517
Mailing Address - Country:US
Mailing Address - Phone:703-772-7592
Mailing Address - Fax:
Practice Address - Street 1:1712 I ST NW STE 410
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3746
Practice Address - Country:US
Practice Address - Phone:703-772-7592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC264739042OtherACUPUNCTURE