Provider Demographics
NPI:1851001069
Name:XIONG, YOUNG VASUA (RPH)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:VASUA
Last Name:XIONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-2686
Mailing Address - Country:US
Mailing Address - Phone:916-614-9502
Mailing Address - Fax:
Practice Address - Street 1:4221 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-2686
Practice Address - Country:US
Practice Address - Phone:916-614-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87395OtherRPH LICENSE NUMBER