Healthcare Provider Details

I. General information

NPI: 1154642437
Provider Name (Legal Business Name): JEFF HUE XIONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 E KINGS CANYON RD # 105
FRESNO CA
93727-3811
US

IV. Provider business mailing address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-8395
  • Fax:
Mailing address:
  • Phone: 559-255-8395
  • Fax: 559-452-8062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: