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NPI Code Detail

MEDICARE: YISHAN XU LCP

MEDICARE: YISHAN XU LCP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist29376CA

General Provider Information

NPI Number : 1093231581
Entity Type Code : Individual
Provider Name (Legal Business Name) : YISHAN XU LCP
Provider Business Mailing Address
First Line : 885 N SAN ANTONIO RD STE O
Second Line :
City : LOS ALTOS
State : CA
Zip : 94022-1341
Country : US
Telephone Number : 650-434-2563
Fax Number :
Provider Business Practice Location Address
First Line : 885 N SAN ANTONIO RD STE O
Second Line :
City : LOS ALTOS
State : CA
Zip : 94022-1341
Country : US
Telephone Number : 650-434-2563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2017
Last Update Date : 03/07/2019

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Directions to “ YISHAN XU LCP” Practice Location

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