Provider Demographics
NPI:1184658742
Name:XU, XIAOMIN (LAC)
Entity Type:Individual
Prefix:
First Name:XIAOMIN
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 1:1698 S. WOLFE RD. STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4868
Mailing Address - Country:US
Mailing Address - Phone:408-738-1538
Mailing Address - Fax:408-738-1538
Practice Address - Street 1:1698 S. WOLFE RD. STE 100
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4868
Practice Address - Country:US
Practice Address - Phone:408-738-1538
Practice Address - Fax:408-738-1538
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7273171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA0072730OtherBLUESHIELD OF CA
CA0659635Medicaid