Provider Demographics
NPI:1821648106
Name:XU, XIAOJUN
Entity Type:Individual
Prefix:
First Name:XIAOJUN
Middle Name:
Last Name:XU
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 1:49 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2528
Mailing Address - Country:US
Mailing Address - Phone:973-866-6838
Mailing Address - Fax:
Practice Address - Street 1:7220 SW ASBURY DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4706
Practice Address - Country:US
Practice Address - Phone:973-866-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist