Provider Demographics
NPI:1407445661
Name:XU, ENDONG
Entity Type:Individual
Prefix:
First Name:ENDONG
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 GERMANTOWN BEND CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7285
Mailing Address - Country:US
Mailing Address - Phone:901-737-8282
Mailing Address - Fax:901-737-8239
Practice Address - Street 1:235 GERMANTOWN BEND CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7285
Practice Address - Country:US
Practice Address - Phone:901-737-8282
Practice Address - Fax:901-737-8239
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU0000000059171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNACU0000000059OtherACUPUNCTURIST