Healthcare Provider Details

I. General information

NPI: 1639709983
Provider Name (Legal Business Name): XIULING HUANG MASSAGE THERAPY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S WINCHESTER BLVD STE D138
SAN JOSE CA
95128-3914
US

IV. Provider business mailing address

1101 S WINCHESTER BLVD STE D138
SAN JOSE CA
95128-3914
US

V. Phone/Fax

Practice location:
  • Phone: 408-394-0288
  • Fax:
Mailing address:
  • Phone: 408-394-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: