Provider Demographics
NPI:1306414370
Name:XIONG, HACK KHOONSRIVONG
Entity Type:Individual
Prefix:
First Name:HACK
Middle Name:KHOONSRIVONG
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 1:4422 N PERSHING AVE STE D2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6967
Mailing Address - Country:US
Mailing Address - Phone:209-953-8843
Mailing Address - Fax:
Practice Address - Street 1:4422 N PERSHING AVE STE D2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6967
Practice Address - Country:US
Practice Address - Phone:209-953-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter