Healthcare Provider Details

I. General information

NPI: 1245012343
Provider Name (Legal Business Name): JULIE XIONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 COOK AVE E
SAINT PAUL MN
55106-3216
US

IV. Provider business mailing address

828 COOK AVE E
SAINT PAUL MN
55106-3216
US

V. Phone/Fax

Practice location:
  • Phone: 651-428-9959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: