Provider Demographics
NPI:1720123011
Name:XU, YAN (LICENSED ACUPUNCTURI)
Entity Type:Individual
Prefix:MISS
First Name:YAN
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PRATT STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6439
Mailing Address - Country:US
Mailing Address - Phone:203-259-7768
Mailing Address - Fax:
Practice Address - Street 1:325 REEF RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6439
Practice Address - Country:US
Practice Address - Phone:203-256-8999
Practice Address - Fax:203-256-9886
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000303171100000X
NY001383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist