Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 23712 | NE |
N | 207ND0101X | MOHS-Micrographic Surgeon | A108442 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | P1948 | TX |
N | 207NS0135X | Procedural Dermatology | A108442 | CA |
NPI | 1225135817 |
---|---|
Provider Name | Yang Xia |
First Address | Boerne, TX 78006-3213 |
Second Address | Boerne, TX 78006-3213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 26/05/2021 |