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SHANGRI-LA INTEGRATED CLINIC NPI 1336707553


NPI Information

NPI: 1336707553
Provider Name: SHANGRI-LA INTEGRATED CLINIC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
13890 BRADDOCK RD STE 300
CENTREVILLE, VA
ZIP 20121
Phone: (571) 655-2281
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SHANGRI-LA INTEGRATED CLINIC is a clinic center in Centreville, VA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). SHANGRI-LA INTEGRATED CLINIC NPI is 1336707553. The provider is registered as an organization entity type.

The provider's business location address is:

13890 BRADDOCK RD STE 300
CENTREVILLE, VA
ZIP 20121-438
Phone: (571) 655-2281

The provider's authorized official is Chung Do Kim .
The authorized official title is Director and has the following contact phone number (571) 218-2393.

The enumeration date for this NPI number is 6/3/2019 and was last updated on 6/11/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10121000910OTHERVIRGINIAN/A

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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