Healthcare Provider Details

I. General information

NPI: 1871723858
Provider Name (Legal Business Name): LESLEY XIONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W 25TH ST
MERCED CA
95340-2838
US

IV. Provider business mailing address

PO BOX 3768
MERCED CA
95344-3768
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-9066
  • Fax: 209-383-1522
Mailing address:
  • Phone: 209-725-7149
  • Fax: 209-726-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA113936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: