Provider Demographics
NPI:1235743360
Name:WANG, XIAODONG (LAC)
Entity Type:Individual
Prefix:
First Name:XIAODONG
Middle Name:
Last Name:WANG
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 1:1051 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-3009
Mailing Address - Country:US
Mailing Address - Phone:712-540-1285
Mailing Address - Fax:
Practice Address - Street 1:111 S STORY ST
Practice Address - Street 2:
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-1525
Practice Address - Country:US
Practice Address - Phone:712-472-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-111171100000X
MN1892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist