Healthcare Provider Details

I. General information

NPI: 1104029800
Provider Name (Legal Business Name): CHARLENE XU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 COLLEGE POINT BLVD APT 1110
FLUSHING NY
11354-5151
US

IV. Provider business mailing address

4028 COLLEGE POINT BLVD APT 1110
FLUSHING NY
11354-5151
US

V. Phone/Fax

Practice location:
  • Phone: 646-894-8963
  • Fax:
Mailing address:
  • Phone: 646-894-8963
  • Fax: 619-268-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002844-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: