Healthcare Provider Details

I. General information

NPI: 1295515484
Provider Name (Legal Business Name): XIONG MEE VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 N 1ST ST
FRESNO CA
93726-0904
US

IV. Provider business mailing address

4615 N 1ST ST
FRESNO CA
93726-0904
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: