MEDICARE: DR. QUN 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	2084N0400X	Neurology Physician	A54136	CA

General Provider Information

NPI Number	:	1174681274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUN XU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5212
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92838-0212
Country	:	US
Telephone Number	:	626-839-4570
Fax Number	:	626-839-4582

Provider Business Practice Location Address
First Line	:	2707 E VALLEY BLVD
Second Line	:	SUITE 205
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3195
Country	:	US
Telephone Number	:	626-839-4570
Fax Number	:	626-839-4582

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	05/03/2012

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