Provider Demographics
NPI:1225112808
Name:XING-JOHNSON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:XING-JOHNSON
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 1:6800 INDIANA AVE
Mailing Address - Street 2:100
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4269
Mailing Address - Country:US
Mailing Address - Phone:951-784-0089
Mailing Address - Fax:951-784-0289
Practice Address - Street 1:6800 INDIANA AVE
Practice Address - Street 2:100
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4269
Practice Address - Country:US
Practice Address - Phone:951-784-0089
Practice Address - Fax:951-784-0289
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3971171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0039710OtherMEDICAL
CAZZZ13585ZOtherBLUE SHIELD OF CALIFORNIA