MEDICARE: TAO XIE L.AC., O.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	6211	CA

General Provider Information

NPI Number	:	1134290430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAO XIE L.AC., O.M.D.

Provider Business Mailing Address
First Line	:	39210 STATE ST
Second Line	:	SUITE 209
City	:	FREMONT
State	:	CA
Zip	:	94538-1456
Country	:	US
Telephone Number	:	510-794-8289
Fax Number	:	510-894-9989

Provider Business Practice Location Address
First Line	:	39210 STATE ST
Second Line	:	SUITE 209
City	:	FREMONT
State	:	CA
Zip	:	94538-1456
Country	:	US
Telephone Number	:	510-794-8289
Fax Number	:	510-894-9989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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