MEDICARE: MALY XIONG LMFT

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	106H00000X	Marriage & Family Therapist	86055	CA

General Provider Information

NPI Number	:	1932218849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALY XIONG LMFT

Provider Business Mailing Address
First Line	:	1212 N CALIFORNIA ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95202-1552
Country	:	US
Telephone Number	:	209-468-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 N PERSHING AVE STE D2
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6967
Country	:	US
Telephone Number	:	209-953-8843
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/20/2024

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