MEDICARE: XONG THAO

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	1041C0700X	Clinical Social Worker	99039	CA

General Provider Information

NPI Number	:	1609158989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XONG THAO

Provider Business Mailing Address
First Line	:	30 GOLDEN LAND CT BLDG 30
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-2423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 GOLDEN LAND CT BLDG G
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-2423
Country	:	US
Telephone Number	:	916-285-6452
Fax Number	:

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

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	06/15/2022

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Directions to “ XONG THAO ” Practice Location

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