Provider Demographics
NPI:1932812591
Name:JIN, XIAO (LAC)
Entity type:Individual
Prefix:
First Name:XIAO
Middle Name:
Last Name:JIN
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 1:7525 DONOHUE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1824
Mailing Address - Country:US
Mailing Address - Phone:415-741-8474
Mailing Address - Fax:
Practice Address - Street 1:1110 VIENNA ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-5619
Practice Address - Country:US
Practice Address - Phone:415-741-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00019610171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty