Healthcare Provider Details

I. General information

NPI: 1306405626
Provider Name (Legal Business Name): XINPING CAO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA CAO LAC, LMT

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E MIDDLE COUNTRY RD STE 3
SMITHTOWN NY
11787-2822
US

IV. Provider business mailing address

323 E MIDDLE COUNTRY RD STE 3
SMITHTOWN NY
11787-2822
US

V. Phone/Fax

Practice location:
  • Phone: 631-780-5511
  • Fax: 631-780-5512
Mailing address:
  • Phone: 631-780-5511
  • Fax: 631-780-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number031492
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: