Provider Demographics
NPI:1962789479
Name:AGHAHOSSEINI, SHIRIN (LAC)
Entity type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:
Last Name:AGHAHOSSEINI
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 1:309B CROSS GREEN ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6481
Mailing Address - Country:US
Mailing Address - Phone:240-832-1111
Mailing Address - Fax:
Practice Address - Street 1:309B CROSS GREEN ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6481
Practice Address - Country:US
Practice Address - Phone:240-832-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA012000167171100000X
MDU1023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist