Provider Demographics
NPI:1619304623
Name:CHEN, XIAO SHAN (LAC- ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:XIAO
Middle Name:SHAN
Last Name:CHEN
Suffix:
Gender:F
Credentials:LAC- ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1125
Mailing Address - Country:US
Mailing Address - Phone:646-427-6078
Mailing Address - Fax:
Practice Address - Street 1:14454 SANFORD AVE APT 18
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1620
Practice Address - Country:US
Practice Address - Phone:646-427-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist