Provider Demographics
NPI:1083830657
Name:XIONG, MAO LEE
Entity Type:Individual
Prefix:
First Name:MAO
Middle Name:LEE
Last Name:XIONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 GRAYSTOKE WAY
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5296
Mailing Address - Country:US
Mailing Address - Phone:559-573-1481
Mailing Address - Fax:
Practice Address - Street 1:3726 GRAYSTOKE WAY
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5296
Practice Address - Country:US
Practice Address - Phone:559-375-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA166559878OtherART NPI NUMBER