Provider Demographics
NPI:1649442898
Name:SHANGHAI CHINESE MEDICINE CLINIC
Entity type:Organization
Organization Name:SHANGHAI CHINESE MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HELMSLEY
Authorized Official - Middle Name:JESOON
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:703-338-1400
Mailing Address - Street 1:2102 GALLOWS RD # C
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3960
Mailing Address - Country:US
Mailing Address - Phone:703-821-1798
Mailing Address - Fax:703-506-9111
Practice Address - Street 1:2102 GALLOWS RD # C
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3960
Practice Address - Country:US
Practice Address - Phone:703-821-1798
Practice Address - Fax:703-506-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty