Healthcare Provider Details

I. General information

NPI: 1851537799
Provider Name (Legal Business Name): XING PENG YUAN RNSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 YOAKUM PKWY # 1016
ALEXANDRIA VA
22304-3800
US

IV. Provider business mailing address

205 YOAKUM PKWY # 1016
ALEXANDRIA VA
22304-3800
US

V. Phone/Fax

Practice location:
  • Phone: 703-888-0217
  • Fax: 703-286-7514
Mailing address:
  • Phone: 703-888-0217
  • Fax: 703-286-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number0001141167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: