Provider Demographics
NPI:1295958429
Name:XUE, LAI FAN
Entity type:Individual
Prefix:
First Name:LAI
Middle Name:FAN
Last Name:XUE
Suffix:
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 1:4310 KISSENA BLVD APT 14A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2973
Mailing Address - Country:US
Mailing Address - Phone:718-321-2461
Mailing Address - Fax:
Practice Address - Street 1:1170 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2900
Practice Address - Country:US
Practice Address - Phone:718-515-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000935171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist