Healthcare Provider Details

I. General information

NPI: 1548210529
Provider Name (Legal Business Name): XIAOHUI XIONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 COFFEE RD SUITE S
MODESTO CA
95355-2050
US

IV. Provider business mailing address

2625 COFFEE RD SUITE S
MODESTO CA
95355-2050
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-1200
  • Fax: 209-577-6517
Mailing address:
  • Phone: 209-577-1200
  • Fax: 209-577-6517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA72455
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA72455
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA72455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: