Provider Demographics
NPI:1811220510
Name:LI, XIAODAN
Entity Type:Individual
Prefix:MRS
First Name:XIAODAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:YOSHIE
Other - Middle Name:
Other - Last Name:ANTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:20445 PACIFICA DR
Mailing Address - Street 2:STE A1
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3017
Mailing Address - Country:US
Mailing Address - Phone:650-766-8718
Mailing Address - Fax:408-996-7358
Practice Address - Street 1:20445 PACIFICA DR
Practice Address - Street 2:STE A1
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3017
Practice Address - Country:US
Practice Address - Phone:650-766-8718
Practice Address - Fax:408-996-7358
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13263171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist