=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083392484
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XIA TCM CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2023
-----------------------------------------------------
Last Update Date | 07/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 LA CASA VIA STE 104A
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-809-0699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 LA CASA VIA STE 104A
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ZHENGFENG XIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-809-0699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------