Provider Demographics
NPI:1083742977
Name:XIE, ZHANG (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ZHANG
Middle Name:
Last Name:XIE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 GENTLE WIND DR.
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883
Mailing Address - Country:US
Mailing Address - Phone:951-371-8888
Mailing Address - Fax:800-626-0068
Practice Address - Street 1:720 MAGNOLIA AVE.
Practice Address - Street 2:STE. B3
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:949-350-1666
Practice Address - Fax:800-626-0068
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4347171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4347OtherLICENSED ACUPUNCTURIST