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General NPI Number Information
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NPI Number | 1225737513
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Entity Type | Individual
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Provider Name | ANNIE JANE XIAO XIAO CANNON PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 11/09/2025
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Provider Practice Location Address
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Address Line | 900 ROUND VALLEY DR
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City | PARK CITY
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State | UT
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Zip | 84060-7552
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Country | US
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Telephone | 435-655-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 2648 E CASTO LN
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City | SALT LAKE CITY
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State | UT
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Zip | 84117-6303
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Country | US
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Telephone | 801-664-6128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 14245481-1206
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License Number State | UT
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