Provider Demographics
NPI:1720457450
Name:SONG, XIN (LAC)
Entity Type:Individual
Prefix:
First Name:XIN
Middle Name:
Last Name:SONG
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 1:456 W SAN JOSE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-6009
Mailing Address - Country:US
Mailing Address - Phone:909-901-9199
Mailing Address - Fax:
Practice Address - Street 1:456 W SAN JOSE AVE STE A
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6009
Practice Address - Country:US
Practice Address - Phone:909-901-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-793171100000X
CAAC18915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist