Provider Demographics
NPI:1467280255
Name:YU, FUDING (MASTER IN MEDICAL)
Entity type:Individual
Prefix:
First Name:FUDING
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:MASTER IN MEDICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11707 BOWMAN GREEN DR FL 1
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3501
Mailing Address - Country:US
Mailing Address - Phone:571-251-2631
Mailing Address - Fax:
Practice Address - Street 1:11707 BOWMAN GREEN DR FL 1
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3501
Practice Address - Country:US
Practice Address - Phone:571-251-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001167171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist