Provider Demographics
NPI:1649676115
Name:SU, CHENGLAN (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:CHENGLAN
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3905
Mailing Address - Country:US
Mailing Address - Phone:301-881-3688
Mailing Address - Fax:301-881-3666
Practice Address - Street 1:6307 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3905
Practice Address - Country:US
Practice Address - Phone:301-881-3688
Practice Address - Fax:301-881-3666
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01163171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist