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General NPI Number Information
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NPI Number | 1235425240
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Entity Type | Organization
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Legal Business Name | XIN DU, A MEDICAL CORP
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 06/28/2011
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Provider Practice Location Address
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Address Line | 124 W 9TH ST
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City | CORONA
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State | CA
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Zip | 92882-3320
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Country | US
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Telephone | 951-582-9627
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Fax | 951-582-0345
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Provider Business Mailing Address
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Address Line | 124 W 9TH ST
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City | CORONA
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State | CA
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Zip | 92882-3320
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Country | US
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Telephone | 951-582-9627
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Fax | 951-582-0345
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Authorized Official
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Title or Position | CEO/OWNER
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Name | XIN DU
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Credential | OMD
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Telephone | 951-582-9627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC5684
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License Number State | CA
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