Provider Demographics
NPI:1114511540
Name:XIONG, JOHNNY
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:XIONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 W PARKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-4448
Mailing Address - Country:US
Mailing Address - Phone:414-334-0006
Mailing Address - Fax:
Practice Address - Street 1:4737 W PARKLAND AVE
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-4448
Practice Address - Country:US
Practice Address - Phone:414-334-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver