Healthcare Provider Details

I. General information

NPI: 1245627439
Provider Name (Legal Business Name): MICHAEL XIONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2015
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2942
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2942
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4500
  • Fax:
Mailing address:
  • Phone: 559-448-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA161316
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD61380723
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: