Provider Demographics
NPI:1568452993
Name:XIONG, JINJUN (MD)
Entity Type:Individual
Prefix:
First Name:JINJUN
Middle Name:
Last Name:XIONG
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 1:2837 WALNUT BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4943
Mailing Address - Country:US
Mailing Address - Phone:925-295-4340
Mailing Address - Fax:
Practice Address - Street 1:5481 W WATERS AVE STE 111
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1256
Practice Address - Country:US
Practice Address - Phone:813-577-4686
Practice Address - Fax:813-577-4688
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235435207ZP0102X
FL134938207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I21953Medicare UPIN