Provider Demographics
NPI:1568910685
Name:XIONG, VILAIVAN (BCBA)
Entity Type:Individual
Prefix:
First Name:VILAIVAN
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VILAIVAN
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5931 WILKINSON ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-3341
Mailing Address - Country:US
Mailing Address - Phone:559-862-9124
Mailing Address - Fax:
Practice Address - Street 1:881 EMBARCADERO DR STE 1
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4092
Practice Address - Country:US
Practice Address - Phone:916-841-5079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-18
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8939103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-15-32354OtherBCBA
CA8939OtherQABA