Provider Demographics
NPI:1891827176
Name:XU, JIAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:JIAN
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:BALDWIN
Other - Middle Name:JIAN
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 32273
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94604-3573
Mailing Address - Country:US
Mailing Address - Phone:510-710-2883
Mailing Address - Fax:
Practice Address - Street 1:905 GENEVA AVE # 203
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3402
Practice Address - Country:US
Practice Address - Phone:510-710-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6529233Medicaid