MEDICARE: XIAO-YAN JIANG LAC

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	004522	NY

General Provider Information

NPI Number	:	1396117917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIAO-YAN JIANG LAC

Provider Business Mailing Address
First Line	:	PO BOX 520391
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11352-0391
Country	:	US
Telephone Number	:	718-886-8180
Fax Number	:	718-886-8183

Provider Business Practice Location Address
First Line	:	9429 75TH ST
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-1005
Country	:	US
Telephone Number	:	917-595-6078
Fax Number	:

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

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	03/15/2025

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