Provider Demographics
NPI:1184009698
Name:WANG, XIAOYAN (L AC)
Entity Type:Individual
Prefix:
First Name:XIAOYAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 WESTERRE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1332
Mailing Address - Country:US
Mailing Address - Phone:804-301-1784
Mailing Address - Fax:
Practice Address - Street 1:3721 WESTERRE PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1332
Practice Address - Country:US
Practice Address - Phone:804-301-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-26
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000324171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0121000324OtherVIRGINIA BOARD OF MEDICINE