=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265245443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JINGHUA XU PH.D., HCLD(ABB)
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3070 MCCANN FARM DR STE 112
-----------------------------------------------------
City | GARNET VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19060-2131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-239-3059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1862 ROYAL MAJESTY CT
-----------------------------------------------------
City | OVIEDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32765-6637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-239-3059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247ZC0005X
-----------------------------------------------------
Taxonomy Name | Clinical Laboratory Director (Non-physician)
-----------------------------------------------------
License Number | DI58386
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------