=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790269058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XLY ACUPUNCTURE CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2018
-----------------------------------------------------
Last Update Date | 10/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 DIXON RD
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-263-3238
-----------------------------------------------------
Fax | 408-247-3203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1613 S MAIN ST STE 101
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-6295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-848-9387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | DR. XIN WANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-848-9387
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------