Provider Demographics
NPI:1740054998
Name:YAO, XUAN (DOM)
Entity type:Individual
Prefix:
First Name:XUAN
Middle Name:
Last Name:YAO
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 WHITLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2489
Mailing Address - Country:US
Mailing Address - Phone:817-583-8808
Mailing Address - Fax:
Practice Address - Street 1:8305 WHITLEY RD STE A
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2489
Practice Address - Country:US
Practice Address - Phone:817-583-8808
Practice Address - Fax:817-583-8808
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02072171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAC02072OtherSTATE LICENSE