Provider Demographics
NPI:1699286096
Name:AN, XIA (LAC)
Entity type:Individual
Prefix:
First Name:XIA
Middle Name:
Last Name:AN
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 1:1536 OLYMPIC AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-4037
Mailing Address - Country:US
Mailing Address - Phone:773-575-3883
Mailing Address - Fax:
Practice Address - Street 1:1536 OLYMPIC AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-4037
Practice Address - Country:US
Practice Address - Phone:773-575-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17825171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist