Provider Demographics
NPI:1982729125
Name:CHAN, XIAO LING (LIC,AC)
Entity Type:Individual
Prefix:
First Name:XIAO
Middle Name:LING
Last Name:CHAN
Suffix:
Gender:F
Credentials:LIC,AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 SEA REEF DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8429
Mailing Address - Country:US
Mailing Address - Phone:619-621-1272
Mailing Address - Fax:619-934-3300
Practice Address - Street 1:4433 CONVOY ST
Practice Address - Street 2:SUITE NUMBER E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3736
Practice Address - Country:US
Practice Address - Phone:619-621-1272
Practice Address - Fax:619-934-3300
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4470171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist