Provider Demographics
NPI:1598306268
Name:XIAO, JINSONG
Entity Type:Individual
Prefix:
First Name:JINSONG
Middle Name:
Last Name:XIAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 N 75TH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6928
Mailing Address - Country:US
Mailing Address - Phone:480-429-8881
Mailing Address - Fax:480-429-8882
Practice Address - Street 1:3225 N 75TH ST STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6928
Practice Address - Country:US
Practice Address - Phone:480-429-8881
Practice Address - Fax:480-429-8882
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-20116225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist