Healthcare Provider Details

I. General information

NPI: 1972975381
Provider Name (Legal Business Name): YANMING XIA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2015
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CANDUN DR STE 104
APEX NC
27523-6413
US

IV. Provider business mailing address

112 WINTERVIEW PL
APEX NC
27539-6246
US

V. Phone/Fax

Practice location:
  • Phone: 919-823-1789
  • Fax: 919-516-9725
Mailing address:
  • Phone: 919-725-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-850
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: