MEDICARE: DANIEL XIE MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207N00000X	Dermatology Physician	25117	NV

General Provider Information

NPI Number	:	1598384828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL XIE MD

Provider Business Mailing Address
First Line	:	12700 PARK CENTRAL DR STE 1210
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1522
Country	:	US
Telephone Number	:	702-360-2763
Fax Number	:	949-783-2880

Provider Business Practice Location Address
First Line	:	400 N STEPHANIE ST STE 400
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6692
Country	:	US
Telephone Number	:	702-990-4800
Fax Number	:	702-990-4808

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

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	05/01/2024

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