Provider Demographics
NPI:1174681274
Name:XU, QUN (MD)
Entity Type:Individual
Prefix:DR
First Name:QUN
Middle Name:
Last Name:XU
Suffix:
Gender:M
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:PO BOX 5212
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-0212
Mailing Address - Country:US
Mailing Address - Phone:626-839-4570
Mailing Address - Fax:626-839-4582
Practice Address - Street 1:2707 E VALLEY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3195
Practice Address - Country:US
Practice Address - Phone:626-839-4570
Practice Address - Fax:626-839-4582
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA541362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54136Medicare ID - Type Unspecified
CAG50206Medicare UPIN