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General NPI Number Information
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NPI Number | 1164191417
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Entity Type | Organization
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Legal Business Name | GLENL XIONG, MDINC
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 500 JESSIE AVE
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City | SACRAMENTO
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State | CA
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Zip | 95838-2609
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Country | US
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Telephone | 916-668-0683
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Fax | 888-719-2432
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Provider Business Mailing Address
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Address Line | 2775 18TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95818-3005
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Country | US
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Telephone | 916-471-8838
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GLEN L XIONG
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Credential | MD
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Telephone | 916-471-8838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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