Provider Demographics
NPI:1245254143
Name:BAO, KEXIN (LAC, PHD)
Entity type:Individual
Prefix:
First Name:KEXIN
Middle Name:
Last Name:BAO
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3256
Mailing Address - Country:US
Mailing Address - Phone:626-288-1199
Mailing Address - Fax:626-288-4199
Practice Address - Street 1:2712 SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3256
Practice Address - Country:US
Practice Address - Phone:626-288-1199
Practice Address - Fax:626-288-4199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3544171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist