Healthcare Provider Details

I. General information

NPI: 1821915927
Provider Name (Legal Business Name): XIAO HAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MERRIMACK ST APT 633
LAWRENCE MA
01843-1765
US

IV. Provider business mailing address

220 MERRIMACK ST APT 633
LAWRENCE MA
01843-1765
US

V. Phone/Fax

Practice location:
  • Phone: 774-329-3045
  • Fax:
Mailing address:
  • Phone: 774-329-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41941
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA5000949
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: