=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902197130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XIAO HUIFANG OB/GYN,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2011
-----------------------------------------------------
Last Update Date | 04/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4161 KISSENA BLVD STE A
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-3105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-939-3588
-----------------------------------------------------
Fax | 718-939-2889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4161 KISSENA BLVD STE A
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-3105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-939-3588
-----------------------------------------------------
Fax | 718-939-2889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. HUIFANG XIAO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-939-3588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 246775
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------