Provider Demographics
NPI:1023389384
Name:FAN, XUE ZHEN
Entity Type:Individual
Prefix:MRS
First Name:XUE ZHEN
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BROADWAY
Mailing Address - Street 2:1203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3005
Mailing Address - Country:US
Mailing Address - Phone:212-334-0589
Mailing Address - Fax:212-334-0589
Practice Address - Street 1:401 BROADWAY
Practice Address - Street 2:1203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3005
Practice Address - Country:US
Practice Address - Phone:212-334-0589
Practice Address - Fax:212-334-0589
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY#003618171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY#003618OtherACUPUNCTURE LICENSE
NY#003618OtherPRACTICE ACUPUNCTURE LICENSE