Provider Demographics
NPI:1023189123
Name:XIA, CHEN-JING (PHD,LAC)
Entity Type:Individual
Prefix:DR
First Name:CHEN-JING
Middle Name:
Last Name:XIA
Suffix:
Gender:M
Credentials:PHD,LAC
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:CHEN-JING
Other - Last Name:XIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD,LAC
Mailing Address - Street 1:145 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4803
Mailing Address - Country:US
Mailing Address - Phone:510-625-8388
Mailing Address - Fax:510-625-8388
Practice Address - Street 1:932 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4222
Practice Address - Country:US
Practice Address - Phone:510-625-8388
Practice Address - Fax:510-625-8388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8907171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0089070Medicaid