MEDICARE: AMY XING-JOHNSON

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	AC3971	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ13585Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1225112808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY XING-JOHNSON

Provider Business Mailing Address
First Line	:	6800 INDIANA AVE
Second Line	:	100
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4269
Country	:	US
Telephone Number	:	951-784-0089
Fax Number	:	951-784-0289

Provider Business Practice Location Address
First Line	:	6800 INDIANA AVE
Second Line	:	100
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4269
Country	:	US
Telephone Number	:	951-784-0089
Fax Number	:	951-784-0289

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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Directions to “ AMY XING-JOHNSON ” Practice Location

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