Provider Demographics
NPI:1205900115
Name:XU, JOHN JUN MING (L AC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JUN MING
Last Name:XU
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5082 SERENO DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3037
Mailing Address - Country:US
Mailing Address - Phone:626-287-2377
Mailing Address - Fax:
Practice Address - Street 1:619 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-3817
Practice Address - Country:US
Practice Address - Phone:626-300-8986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5791171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0057910Medicaid