Healthcare Provider Details

I. General information

NPI: 1265488340
Provider Name (Legal Business Name): XIAOMING DONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55422-4215
US

IV. Provider business mailing address

4225 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55422-4215
US

V. Phone/Fax

Practice location:
  • Phone: 763-588-0661
  • Fax: 763-302-4345
Mailing address:
  • Phone: 763-588-0661
  • Fax: 763-287-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number47188
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number47188
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: