Provider Demographics
NPI:1629199773
Name:XIA, YAN Y (LIC AC)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:Y
Last Name:XIA
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1850
Mailing Address - Country:US
Mailing Address - Phone:617-432-1335
Mailing Address - Fax:
Practice Address - Street 1:72 KNEELAND ST
Practice Address - Street 2:ROOM 303
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1919
Practice Address - Country:US
Practice Address - Phone:617-432-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA429171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist