Provider Demographics
NPI:1801673827
Name:FANG, YILAN (LAC)
Entity type:Individual
Prefix:MRS
First Name:YILAN
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:JUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:3126 HARRISON HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2330
Mailing Address - Country:US
Mailing Address - Phone:571-240-9110
Mailing Address - Fax:703-825-7131
Practice Address - Street 1:3927 BLENHEIM BLVD STE 101D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2422
Practice Address - Country:US
Practice Address - Phone:571-240-9110
Practice Address - Fax:703-825-7131
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001123171100000X
MDU02937171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist