Provider Demographics
NPI:1164191417
Name:GLENL XIONG, MDINC
Entity Type:Organization
Organization Name:GLENL XIONG, MDINC
Other - Org Name:GENERATIVE HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-471-8838
Mailing Address - Street 1:2775 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3005
Mailing Address - Country:US
Mailing Address - Phone:916-471-8838
Mailing Address - Fax:
Practice Address - Street 1:500 JESSIE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-2609
Practice Address - Country:US
Practice Address - Phone:916-668-0683
Practice Address - Fax:888-719-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care