Provider Demographics
NPI:1114053675
Name:SHEN, XIAOTIAN (LAC)
Entity type:Individual
Prefix:MR
First Name:XIAOTIAN
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11651 JOLLYVILLE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4106
Mailing Address - Country:US
Mailing Address - Phone:512-331-3866
Mailing Address - Fax:
Practice Address - Street 1:11651 JOLLYVILLE RD STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4106
Practice Address - Country:US
Practice Address - Phone:512-331-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00497171100000X
TXAC00497171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist