Provider Demographics
NPI:1700228582
Name:XIE, WENJIE (LAC)
Entity Type:Individual
Prefix:
First Name:WENJIE
Middle Name:
Last Name:XIE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3223 DEL MAR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2327
Mailing Address - Country:US
Mailing Address - Phone:626-280-9608
Mailing Address - Fax:626-280-2176
Practice Address - Street 1:3223 DEL MAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2327
Practice Address - Country:US
Practice Address - Phone:626-280-9608
Practice Address - Fax:626-280-2176
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14869171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist