Provider Demographics
NPI:1629502901
Name:XIONG, TONG
Entity Type:Individual
Prefix:
First Name:TONG
Middle Name:
Last Name:XIONG
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 1:1092 COOK AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3323
Mailing Address - Country:US
Mailing Address - Phone:651-235-5739
Mailing Address - Fax:
Practice Address - Street 1:1092 COOK AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3323
Practice Address - Country:US
Practice Address - Phone:651-235-5739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108423-1-AFC374U00000X
MN1085126-1-HCBS374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide