Healthcare Provider Details

I. General information

NPI: 1841871704
Provider Name (Legal Business Name): WARREN J XIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 10/25/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W HELLMAN AVE STE 302
MONTEREY PARK CA
91754-1209
US

IV. Provider business mailing address

16 W BIRCHCROFT ST
ARCADIA CA
91007-5101
US

V. Phone/Fax

Practice location:
  • Phone: 626-299-2020
  • Fax:
Mailing address:
  • Phone: 626-201-0352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number35186-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: