Provider Demographics
NPI:1275619439
Name:WANG, XIN M (LAC)
Entity Type:Individual
Prefix:
First Name:XIN
Middle Name:M
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10782 BELLAIRE BLVD,#C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2759
Mailing Address - Country:US
Mailing Address - Phone:281-776-9085
Mailing Address - Fax:281-776-9641
Practice Address - Street 1:10782 BELLAIRE BLVD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2759
Practice Address - Country:US
Practice Address - Phone:281-776-9085
Practice Address - Fax:281-776-9641
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00570171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAC00570OtherACUPUNCTURIST