Healthcare Provider Details

I. General information

NPI: 1770492639
Provider Name (Legal Business Name): MAIKOU XIONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 SIERRA PARK RD
MAMMOTH LAKES CA
93546
US

IV. Provider business mailing address

37 EMIGRANT ST
BRIDGEPORT CA
93517
US

V. Phone/Fax

Practice location:
  • Phone: 760-934-0031
  • Fax:
Mailing address:
  • Phone: 559-978-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: