Provider Demographics
NPI:1902902216
Name:XIAO, XINFANG (PHD, OMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:XINFANG
Middle Name:
Last Name:XIAO
Suffix:
Gender:F
Credentials:PHD, OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 N PONDEROSA DR
Mailing Address - Street 2:SUITE A109
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2398
Mailing Address - Country:US
Mailing Address - Phone:805-389-9622
Mailing Address - Fax:805-389-9544
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1501
Practice Address - Country:US
Practice Address - Phone:805-389-9622
Practice Address - Fax:805-389-9544
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4390171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0453236OtherFEDERAK TAX ID