Healthcare Provider Details

I. General information

NPI: 1740017540
Provider Name (Legal Business Name): CHANGQING XIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EPPLEY SCIENCE HALL (ESH) ROOM 9021 985440 NEBRASKA MEDICAL CENTER
OMAHA NE
68198
US

IV. Provider business mailing address

EPPLEY SCIENCE HALL (ESH) ROOM 9021 985440 NEBRASKA MEDICAL CENTER
OMAHA NE
68198
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-9914
  • Fax:
Mailing address:
  • Phone: 402-559-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number45628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: