Provider Demographics
NPI:1003046814
Name:XIE, VINCENT (LAC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:XIE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1308 CONCANNON BLVD
Mailing Address - Street 2:BLDG J
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6004
Mailing Address - Country:US
Mailing Address - Phone:925-292-5567
Mailing Address - Fax:925-292-5751
Practice Address - Street 1:1308 CONCANNON BLVD
Practice Address - Street 2:BLDG J
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6004
Practice Address - Country:US
Practice Address - Phone:925-292-5567
Practice Address - Fax:925-292-5751
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC12851171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist