Provider Demographics
NPI:1114006012
Name:ZHAO, XIAOYUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:XIAOYUAN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BOWERY,
Mailing Address - Street 2:#401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-966-8454
Mailing Address - Fax:212-966-1846
Practice Address - Street 1:80 BOWERY
Practice Address - Street 2:#401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4614
Practice Address - Country:US
Practice Address - Phone:212-966-8454
Practice Address - Fax:212-966-1846
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190325Medicaid
NY017AI1Medicare ID - Type Unspecified
NYH49218Medicare UPIN