Organization · NPI-2

Shangri-La Integrated Clinic

Clinic/Center · Centreville, VA

NPI number1336707553
StatusActive
Last updated in NPPESJun 11, 2019

Details

NPI
1336707553
Entity type
Organization (NPI-2)
Legal business name
Shangri-La Integrated Clinic
Organization subpart
No
Enumeration date
Jun 3, 2019
Last updated
Jun 11, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

13890 Braddock Rd Ste 300
Centreville, VA 20121-2438

Phone 571-655-2281

Mailing address

13890 Braddock Rd Ste 300
Centreville, VA 20121-2438

Phone 571-655-2281

Authorized official

Chung DO Kim
Director
5712182393

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