Provider Demographics
NPI:1407357072
Name:FOUR SEASONS ACUPUNCTURE & WELLNESS
Entity type:Organization
Organization Name:FOUR SEASONS ACUPUNCTURE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WONSIK
Authorized Official - Middle Name:
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:703-717-8573
Mailing Address - Street 1:11130 FAIRFAX BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5035
Mailing Address - Country:US
Mailing Address - Phone:703-717-8573
Mailing Address - Fax:703-563-9383
Practice Address - Street 1:11130 FAIRFAX BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5035
Practice Address - Country:US
Practice Address - Phone:703-717-8573
Practice Address - Fax:703-563-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000772261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain