Provider Demographics
NPI:1932639549
Name:ZHOU-MEDAGLI, XIAOYAN
Entity Type:Individual
Prefix:
First Name:XIAOYAN
Middle Name:
Last Name:ZHOU-MEDAGLI
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 1:3164 PUTNAM BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-1868
Mailing Address - Country:US
Mailing Address - Phone:925-219-5379
Mailing Address - Fax:925-930-9782
Practice Address - Street 1:3164 PUTNAM BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597
Practice Address - Country:US
Practice Address - Phone:925-219-5379
Practice Address - Fax:925-930-9782
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF8232508OtherCALIFORNIA DRIVER LICENSE