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General NPI Number Information
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NPI Number | 1437782752
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Entity Type | Individual
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Provider Name | XIN TIAN
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Gender | Female
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 1818 DEMPSTER ST
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City | EVANSTON
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State | IL
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Zip | 60202-1003
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Country | US
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Telephone | 224-707-0998
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Fax |
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Provider Business Mailing Address
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Address Line | 420 LINDEN AVE APT 501
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City | WILMETTE
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State | IL
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Zip | 60091-2876
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 198001377
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License Number State | IL
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