Provider Demographics
NPI:1154445393
Name:HOM, LILY XIU XIA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:XIU XIA
Last Name:HOM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:LILY
Other - Middle Name:SH
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:12394 BRASSICA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4126
Mailing Address - Country:US
Mailing Address - Phone:858-538-6827
Mailing Address - Fax:
Practice Address - Street 1:2841 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2928
Practice Address - Country:US
Practice Address - Phone:619-297-0446
Practice Address - Fax:619-297-2628
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1574171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist