Provider Demographics
NPI:1124294509
Name:XU, XIANGYU (OMD)
Entity type:Individual
Prefix:DR
First Name:XIANGYU
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 NE SUNSET BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4018
Mailing Address - Country:US
Mailing Address - Phone:425-255-2600
Mailing Address - Fax:425-255-2601
Practice Address - Street 1:4444 NE SUNSET BLVD STE 2
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4018
Practice Address - Country:US
Practice Address - Phone:425-255-2600
Practice Address - Fax:425-255-2601
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003079171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC00003079OtherWASHINGTON LICENSE