Provider Demographics
NPI:1871780296
Name:MOU, XIAODE
Entity type:Individual
Prefix:DR
First Name:XIAODE
Middle Name:
Last Name:MOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TERRYVILLE RD
Mailing Address - Street 2:#1A
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1300
Mailing Address - Country:US
Mailing Address - Phone:917-648-6760
Mailing Address - Fax:
Practice Address - Street 1:23 TECHNOLOGY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4075
Practice Address - Country:US
Practice Address - Phone:631-246-6461
Practice Address - Fax:631-246-6461
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist