Provider Demographics
NPI:1649886722
Name:WU, SURYA
Entity type:Individual
Prefix:DR
First Name:SURYA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JINGPING
Other - Middle Name:
Other - Last Name:YAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10875 MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4732
Mailing Address - Country:US
Mailing Address - Phone:240-489-1818
Mailing Address - Fax:
Practice Address - Street 1:10875 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4732
Practice Address - Country:US
Practice Address - Phone:240-489-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121-000984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist