Healthcare Provider Details

I. General information

NPI: 1164341509
Provider Name (Legal Business Name): KUNBO XIAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43-14 QUEENS ST 12N
LONG ISLAND CITY NY
11101
US

IV. Provider business mailing address

43-14 QUEENS ST 12N
LONG ISLAND CITY NY
11101
US

V. Phone/Fax

Practice location:
  • Phone: 424-422-6277
  • Fax:
Mailing address:
  • Phone: 424-422-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: