Provider Demographics
NPI:1700868155
Name:XIE, KEVIN C (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:XIE
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 1:12117 PASEO TERRAZA LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1125
Mailing Address - Country:US
Mailing Address - Phone:320-333-0789
Mailing Address - Fax:
Practice Address - Street 1:5115 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0189
Practice Address - Country:US
Practice Address - Phone:320-333-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN427892084N0400X
NV166922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
127992OtherU CARE
1074702OtherARAZ GROUP AMERICAS PPO
2116433OtherFIRST HEALTH PLAN
692640100OtherMEDICAL ASSISTANCE
0500113OtherMEDICA HEALTH PLANS
1024908OtherPREFERRED ONE
71Q61X1OtherBLUE CROSS BLUE SHIELD
HP30996OtherHEALTH PARTNERS
692640100OtherMEDICAL ASSISTANCE
71Q61X1OtherBLUE CROSS BLUE SHIELD