Provider Demographics
NPI:1013088541
Name:XU, MING SHAN JR
Entity Type:Individual
Prefix:MISS
First Name:MING
Middle Name:SHAN
Last Name:XU
Suffix:JR
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 1:714 C ST
Mailing Address - Street 2:#202
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3825
Mailing Address - Country:US
Mailing Address - Phone:415-459-1676
Mailing Address - Fax:415-453-7053
Practice Address - Street 1:714 C ST
Practice Address - Street 2:#202
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3825
Practice Address - Country:US
Practice Address - Phone:415-459-1676
Practice Address - Fax:415-453-7053
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4982171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAI717723OtherACUPUNCTURIST