Healthcare Provider Details

I. General information

NPI: 1861314452
Provider Name (Legal Business Name): XUANLING TANG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30313 CANWOOD ST STE 23
AGOURA HILLS CA
91301-2034
US

IV. Provider business mailing address

1539 KWIS AVE
HACIENDA HEIGHTS CA
91745-2715
US

V. Phone/Fax

Practice location:
  • Phone: 818-651-9899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: