Provider Demographics
NPI:1104045780
Name:XU, JIANA (LAC)
Entity Type:Individual
Prefix:
First Name:JIANA
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E 82ND ST
Mailing Address - Street 2:1H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14218 38TH AVE
Practice Address - Street 2:#CF-D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5550
Practice Address - Country:US
Practice Address - Phone:718-886-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist