Healthcare Provider Details

I. General information

NPI: 1225698830
Provider Name (Legal Business Name): SIYUN XIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-2682
US

IV. Provider business mailing address

3238 SUNRISE CT
ZIONSVILLE IN
46077-7841
US

V. Phone/Fax

Practice location:
  • Phone: 505-322-6687
  • Fax: 505-369-3406
Mailing address:
  • Phone: 317-289-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME175637
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA187221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: