Healthcare Provider Details

I. General information

NPI: 1457269409
Provider Name (Legal Business Name): EILEEN XUE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 S MOONEY BLVD STE B
VISALIA CA
93277-9147
US

IV. Provider business mailing address

2301 WEYRICH CT
TULARE CA
93274-7729
US

V. Phone/Fax

Practice location:
  • Phone: 559-732-1953
  • Fax:
Mailing address:
  • Phone: 559-467-6997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: