MEDICARE: XUE XIA CHONG L. AC.

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	25004509	NY

General Provider Information

NPI Number	:	1992093504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XUE XIA CHONG L. AC.

Provider Business Mailing Address
First Line	:	1062 67TH ST
Second Line	:	APT 3B
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5980
Country	:	US
Telephone Number	:	917-603-3906
Fax Number	:	631-444-1230

Provider Business Practice Location Address
First Line	:	1062 67TH ST
Second Line	:	APT 3B
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5980
Country	:	US
Telephone Number	:	917-603-3906
Fax Number	:	631-444-1230

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

Provider Enumeration Date	:	07/17/2011
Last Update Date	:	01/17/2012

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