Provider Demographics
NPI:1760887400
Name:MA, XIN (MAC, LAC)
Entity Type:Individual
Prefix:DR
First Name:XIN
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAC, LAC
Mailing Address - Street 1:9282 GAITHER RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1420
Mailing Address - Country:US
Mailing Address - Phone:301-330-1184
Mailing Address - Fax:240-788-9158
Practice Address - Street 1:9282 GAITHER RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1420
Practice Address - Country:US
Practice Address - Phone:301-330-1184
Practice Address - Fax:240-788-9158
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02173171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist