Provider Demographics
NPI:1306593744
Name:KU, AHYOUNG (LAC)
Entity type:Individual
Prefix:
First Name:AHYOUNG
Middle Name:
Last Name:KU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 CHAIN BRIDGE RD STE 202-204
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5726
Mailing Address - Country:US
Mailing Address - Phone:703-407-8047
Mailing Address - Fax:
Practice Address - Street 1:1493 CHAIN BRIDGE RD STE 202-204
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5726
Practice Address - Country:US
Practice Address - Phone:571-332-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001082171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174127799OtherBEYOND ACUPUNCTURE, LLC