Provider Demographics
NPI:1265791131
Name:WAH, BRIAN P (LAC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:WAH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13227 PLEASANTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3015
Mailing Address - Country:US
Mailing Address - Phone:703-867-6323
Mailing Address - Fax:
Practice Address - Street 1:443 CARLISLE DR STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5623
Practice Address - Country:US
Practice Address - Phone:703-867-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121-000669171100000X
MDU01956171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist