Healthcare Provider Details

I. General information

NPI: 1548626526
Provider Name (Legal Business Name): YANG XIA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W SAN ANTONIO AVE # 100
BOERNE TX
78006-3213
US

IV. Provider business mailing address

745 W SAN ANTONIO AVE # 100
BOERNE TX
78006-3213
US

V. Phone/Fax

Practice location:
  • Phone: 830-331-9900
  • Fax:
Mailing address:
  • Phone: 830-331-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberP1948
License Number StateTX

VIII. Authorized Official

Name: YANG XIA
Title or Position: PRESIDENT
Credential: MD
Phone: 210-215-0064