MEDICARE: DR. GUANG-QIAN XIAO MD, PHD.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	C143115	CA

General Provider Information

NPI Number	:	1962416750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUANG-QIAN XIAO MD, PHD.

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-442-2582
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 SAN PABLO ST
Second Line	:	2ND FLOOR PATHOLOGY LAB
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-4500
Country	:	US
Telephone Number	:	323-442-2582
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	11/10/2020

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