MEDICARE: LINYING XIAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1255075354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINYING XIAO

Provider Business Mailing Address
First Line	:	2517 ABBEY DR APT 4
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 ABBEY DR APT 4
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3124
Country	:	US
Telephone Number	:	720-550-2192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	06/07/2022

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Directions to “ LINYING XIAO ” Practice Location

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