Provider Demographics
NPI:1972157931
Name:CHIN, XIAOYUE O
Entity Type:Individual
Prefix:
First Name:XIAOYUE
Middle Name:O
Last Name:CHIN
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 1:23727 LEGEND GLN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4316
Mailing Address - Country:US
Mailing Address - Phone:503-781-3464
Mailing Address - Fax:
Practice Address - Street 1:23727 LEGEND GLN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-4316
Practice Address - Country:US
Practice Address - Phone:503-781-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25069225700000X
TX135427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist