Provider Demographics
NPI:1649611559
Name:WANG, XIAO P (LAC)
Entity type:Individual
Prefix:DR
First Name:XIAO
Middle Name:P
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 BURNS ST
Mailing Address - Street 2:APT 1V
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3948
Mailing Address - Country:US
Mailing Address - Phone:347-898-7596
Mailing Address - Fax:
Practice Address - Street 1:66-01 BURNS ST
Practice Address - Street 2:APT 1V
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:347-898-7596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004648171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist