Provider Demographics
NPI:1386671642
Name:XU, JUN (MD)
Entity Type:Individual
Prefix:
First Name:JUN
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 1:1171 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1426
Mailing Address - Country:US
Mailing Address - Phone:203-637-7720
Mailing Address - Fax:203-637-2693
Practice Address - Street 1:1171 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1426
Practice Address - Country:US
Practice Address - Phone:203-637-7720
Practice Address - Fax:203-637-2693
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038206208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH12103Medicare UPIN
CT250000283Medicare PIN