Healthcare Provider Details

I. General information

NPI: 1326762691
Provider Name (Legal Business Name): JING XU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 ELLIS ST
SAN FRANCISCO CA
94109-7714
US

IV. Provider business mailing address

PO BOX 722
CUPERTINO CA
95015-0722
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-4186
  • Fax:
Mailing address:
  • Phone: 650-466-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: