Shangri-la Integrated Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SHANGRI-LA INTEGRATED CLINIC

Practice address

13890 Braddock Rd Ste 300
Centreville, VA 20121-2438

Phone

(571) 655-2281

NPI assigned

Jun 3, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chung DO Kim

Title

Director

Phone

(571) 218-2393

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Young Su Kim

  • Acupuncturist
  • Centreville, VA
  • NPI 1114480548
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1336707553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13890 BRADDOCK RD STE 300",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212438",
            "telephone_number": "571-655-2281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13890 BRADDOCK RD STE 300",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212438",
            "telephone_number": "571-655-2281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANGRI-LA INTEGRATED CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-03",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CHUNG DO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "571-218-2393"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "0121000910",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Senior Citizens Aides LLC
• Seoul Acupuncture Clinic LLC
• Donna Marie Shaffer, RN
• Lutfunnessa Parveen Shafi, M.D
• Sumaira Shakir, DO
• Kathleen Shearer, ANP
• Sheela M. Kadekar, M.D. P.L.L.C.
• Nimo Sheikh-Adam
• Stacey T Shepherd, PA-C
• Matthew Jaesik Shin, D.C.

• Clinic/Center in Centreville, VA
• Providers in Centreville, VA by specialty
• Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.