Provider Demographics
NPI:1245767581
Name:XIA, XUE
Entity type:Individual
Prefix:
First Name:XUE
Middle Name:
Last Name:XIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SNOW
Other - Middle Name:
Other - Last Name:XIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1182 BROADWAY STE 3A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5403
Mailing Address - Country:US
Mailing Address - Phone:646-807-8848
Mailing Address - Fax:
Practice Address - Street 1:1182 BROADWAY STE 3A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5403
Practice Address - Country:US
Practice Address - Phone:646-807-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005942171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist