Provider Demographics
NPI:1326069139
Name:LI, XIAO HONG (MD)
Entity Type:Individual
Prefix:DR
First Name:XIAO
Middle Name:HONG
Last Name:LI
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:PO BOX 5917
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5917
Mailing Address - Country:US
Mailing Address - Phone:713-378-3180
Mailing Address - Fax:713-943-2323
Practice Address - Street 1:4301 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2117
Practice Address - Country:US
Practice Address - Phone:713-378-3180
Practice Address - Fax:713-943-2323
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030613601Medicaid
TX00561JMedicare ID - Type UnspecifiedMEDICARE
TX030613601Medicaid