Healthcare Provider Details

I. General information

NPI: 1083392484
Provider Name (Legal Business Name): XIA TCM CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 LA CASA VIA STE 104A
WALNUT CREEK CA
94598-3013
US

IV. Provider business mailing address

108 LA CASA VIA STE 104A
WALNUT CREEK CA
94598-3013
US

V. Phone/Fax

Practice location:
  • Phone: 925-809-0699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ZHENGFENG XIA
Title or Position: OWNER
Credential:
Phone: 925-809-0699