Provider Demographics
NPI:1407257934
Name:XU, XIAO DAN (SERVICE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:XIAO DAN
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 99TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1857
Mailing Address - Country:US
Mailing Address - Phone:718-962-0888
Mailing Address - Fax:718-271-0722
Practice Address - Street 1:9825 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4627
Practice Address - Country:US
Practice Address - Phone:718-962-0888
Practice Address - Fax:718-271-0722
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator