Healthcare Provider Details

I. General information

NPI: 1053965251
Provider Name (Legal Business Name): GUANGYU XIA DACM, DIPL.OM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2723 FOXCROFT RD STE 103
LITTLE ROCK AR
72227-6511
US

IV. Provider business mailing address

5400 CHENONCEAU BLVD APT 532
LITTLE ROCK AR
72223-4744
US

V. Phone/Fax

Practice location:
  • Phone: 501-312-9888
  • Fax:
Mailing address:
  • Phone: 626-258-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number080
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: