Provider Demographics
NPI:1972648749
Name:XIAO, SI QUAN (OMD)
Entity Type:Individual
Prefix:MR
First Name:SI
Middle Name:QUAN
Last Name:XIAO
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 E GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755
Mailing Address - Country:US
Mailing Address - Phone:626-307-9288
Mailing Address - Fax:626-307-8880
Practice Address - Street 1:428 E GARVEY AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755
Practice Address - Country:US
Practice Address - Phone:626-307-9288
Practice Address - Fax:626-307-8880
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10147Medicare ID - Type Unspecified