Provider Demographics
NPI:1700172285
Name:XIN, BAOYU
Entity Type:Individual
Prefix:
First Name:BAOYU
Middle Name:
Last Name:XIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17010 CALLE TREVINO, UNIT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127
Mailing Address - Country:US
Mailing Address - Phone:619-272-1281
Mailing Address - Fax:
Practice Address - Street 1:15525 POMERADO RD., SUITE E4
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:619-272-1281
Practice Address - Fax:858-451-1104
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12984171100000X
CAAC12984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist