Provider Demographics
NPI:1790265577
Name:XU, KE (MSC)
Entity Type:Individual
Prefix:MRS
First Name:KE
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:MRS
Other - First Name:KEREN
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSC
Mailing Address - Street 1:6268 N SAN GABRIEL BLVD.
Mailing Address - Street 2:APT 17
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:91775
Mailing Address - Country:US
Mailing Address - Phone:626-210-7496
Mailing Address - Fax:626-577-2305
Practice Address - Street 1:9353 VALLEY BLVD C ROSEMEND,ASIAN PACIFIC FAMILY CENTER
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:91770
Practice Address - Country:US
Practice Address - Phone:626-287-2988
Practice Address - Fax:626-577-2305
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXEK906417606OtherBLUE SHIELD