Provider Demographics
NPI:1508992181
Name:XU, SHANLEI (LICACUPUNCTURIST)
Entity Type:Individual
Prefix:DR
First Name:SHANLEI
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:LICACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24645 STRATTON LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2179
Mailing Address - Country:US
Mailing Address - Phone:949-249-5312
Mailing Address - Fax:
Practice Address - Street 1:24692 DEL PRADO
Practice Address - Street 2:# C
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3841
Practice Address - Country:US
Practice Address - Phone:949-493-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7268171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist