MEDICARE: DR. LISA YUN XU M.D.

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	207N00000X	Dermatology Physician	01068724A	IN
2	207N00000X	Dermatology Physician	D75158	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013118256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA YUN XU M.D.

Provider Business Mailing Address
First Line	:	5010 CAMPUS DR STE 120
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 CAMPUS DR STE 120
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2120
Country	:	US
Telephone Number	:	949-773-4784
Fax Number	:

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	10/19/2023

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