Healthcare Provider Details

I. General information

NPI: 1841776358
Provider Name (Legal Business Name): SHUO XU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD RM 8725
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

435 ARNAZ DR APT 102
LOS ANGELES CA
90048-3963
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-8211
  • Fax:
Mailing address:
  • Phone: 310-871-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA157510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: