Provider Demographics
NPI:1356089825
Name:XIAO, CHUNYUN
Entity Type:Individual
Prefix:
First Name:CHUNYUN
Middle Name:
Last Name:XIAO
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 1:2819 N FITZHUGH AVE APT 2207
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3184
Mailing Address - Country:US
Mailing Address - Phone:850-501-1422
Mailing Address - Fax:
Practice Address - Street 1:2819 N FITZHUGH AVE APT 2207
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3184
Practice Address - Country:US
Practice Address - Phone:850-501-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty