Provider Demographics
NPI:1093288276
Name:XING, SHANSHAN
Entity Type:Individual
Prefix:
First Name:SHANSHAN
Middle Name:
Last Name:XING
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 1:3499 NE JOHN OLSEN AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5808
Mailing Address - Country:US
Mailing Address - Phone:858-348-7891
Mailing Address - Fax:503-844-4195
Practice Address - Street 1:3499 NE JOHN OLSEN AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5808
Practice Address - Country:US
Practice Address - Phone:858-348-7891
Practice Address - Fax:503-844-4195
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist