Provider Demographics
NPI:1659557585
Name:XIAO, SUHONG
Entity Type:Individual
Prefix:
First Name:SUHONG
Middle Name:
Last Name:XIAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13688 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8448
Mailing Address - Country:US
Mailing Address - Phone:317-340-4049
Mailing Address - Fax:866-684-9253
Practice Address - Street 1:13688 STANFORD DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8448
Practice Address - Country:US
Practice Address - Phone:317-340-4049
Practice Address - Fax:866-684-9253
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000026A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN705257OtherACN GROUP