Healthcare Provider Details

I. General information

NPI: 1942226626
Provider Name (Legal Business Name): XUAN LILY CHANG DAOM., LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10951 SORRENTO VALLEY RD STE 1B
SAN DIEGO CA
92121-1613
US

IV. Provider business mailing address

13371 DARVIEW LN
SAN DIEGO CA
92129-2389
US

V. Phone/Fax

Practice location:
  • Phone: 858-780-9468
  • Fax: 413-751-0277
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number6357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: