Provider Demographics
NPI:1992713523
Name:LI, XIAORONG LINDA (DOM)
Entity type:Individual
Prefix:
First Name:XIAORONG
Middle Name:LINDA
Last Name:LI
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1517 EUBANK BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4112
Mailing Address - Country:US
Mailing Address - Phone:505-294-7368
Mailing Address - Fax:505-294-7424
Practice Address - Street 1:1517 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4112
Practice Address - Country:US
Practice Address - Phone:505-294-7368
Practice Address - Fax:505-294-7424
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM267171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist