Provider Demographics
NPI:1407210602
Name:JORDAN, XILIN FENG (LAC)
Entity Type:Individual
Prefix:
First Name:XILIN
Middle Name:FENG
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3704
Mailing Address - Country:US
Mailing Address - Phone:203-776-7888
Mailing Address - Fax:
Practice Address - Street 1:2295 STATE ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-3704
Practice Address - Country:US
Practice Address - Phone:203-776-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000342171100000X
CT000342171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist