Provider Demographics
NPI:1629417027
Name:XUE, SONG QING (L AC)
Entity Type:Individual
Prefix:
First Name:SONG QING
Middle Name:
Last Name:XUE
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 MERIDIEN CIR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1673
Mailing Address - Country:US
Mailing Address - Phone:510-585-8975
Mailing Address - Fax:
Practice Address - Street 1:2910 MERIDIEN CIR
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1673
Practice Address - Country:US
Practice Address - Phone:510-585-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15501171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist