MEDICARE: DR. XIAODE MOU

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
1	171100000X	Acupuncturist	002038	NY

General Provider Information

NPI Number	:	1871780296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XIAODE MOU

Provider Business Mailing Address
First Line	:	125 TERRYVILLE RD
Second Line	:	#1A
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-1300
Country	:	US
Telephone Number	:	917-648-6760
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 TECHNOLOGY DR
Second Line	:	SUITE 3
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-4075
Country	:	US
Telephone Number	:	631-246-6461
Fax Number	:	631-246-6461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2007
Last Update Date	:	09/30/2007

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