Provider Demographics
NPI:1649739038
Name:XIONG, KOU
Entity Type:Individual
Prefix:
First Name:KOU
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 1:1323 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5816
Mailing Address - Country:US
Mailing Address - Phone:715-870-1166
Mailing Address - Fax:
Practice Address - Street 1:1323 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5816
Practice Address - Country:US
Practice Address - Phone:715-870-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care