Organization
SHANGRI-LA INTEGRATED CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHUNG DO KIM (DIRECTOR)
(571) 218-2393
Entity
Organization
Contact information
Practice address
13890 BRADDOCK RD STE 300, CENTREVILLE, VA 20121-2438
(571) 655-2281
Mailing address
13890 BRADDOCK RD STE 300, CENTREVILLE, VA 20121-2438
(571) 655-2281
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0121000910
N/A
VA
Enumeration date
06/03/2019
Last updated
06/11/2019
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