NPIMap

Organization Active NPI

Four Seasons Acupuncture & Wellness

  • Pain Clinic/Center
  • Fairfax, VA
National Provider Identifier
1407357072
Registry record updated Feb 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
License
0121000772 Issued in VA
Legal business name
FOUR SEASONS ACUPUNCTURE & WELLNESS
Practice address
11130 Fairfax Blvd Ste 204
Fairfax, VA 22030-5035
Phone
(703) 717-8573
Fax
(703) 563-9383
NPI assigned
Feb 28, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2018

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

Authorized official

Name
Mr. Wonsik Um, LACNPI 1922463876
Title
President
Phone
(703) 717-8573

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Clinic/Center 261QP3300X 0121000772 VA Primary

Addresses

Primary practice location

11130 Fairfax Blvd Ste 204
Fairfax, VA 22030-5035

Mailing address

11130 Fairfax Blvd Ste 204
Fairfax, VA 22030-5035
Phone (703) 717-8573

National Provider Directory

National Provider Directory

Locations

11130 Fairfax Blvd
Ste 204
Fairfax, VA 22030
Phone (703) 717-8573

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519776000000",
    "number": "1407357072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11130 FAIRFAX BLVD STE 204",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305035",
            "telephone_number": "703-717-8573",
            "fax_number": "703-563-9383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11130 FAIRFAX BLVD STE 204",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305035",
            "telephone_number": "703-717-8573",
            "fax_number": "703-563-9383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR SEASONS ACUPUNCTURE & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "last_updated": "2018-02-28",
        "status": "A",
        "authorized_official_last_name": "UM",
        "authorized_official_first_name": "WONSIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-717-8573",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "VA",
            "license": "0121000772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2018; 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.