MEDICARE: KONG CHENG XIONG RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	95124143	CA

General Provider Information

NPI Number	:	1265964498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KONG CHENG XIONG RN

Provider Business Mailing Address
First Line	:	3150 E SHIELDS AVE STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6901
Country	:	US
Telephone Number	:	559-538-1727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3127 N MILLBROOK AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-1425
Country	:	US
Telephone Number	:	559-453-1008
Fax Number	:

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

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	05/19/2026

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