Provider Demographics
NPI:1891711636
Name:XIE, SHERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:XIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:304
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-254-1281
Mailing Address - Fax:626-254-1297
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:304
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7606
Practice Address - Country:US
Practice Address - Phone:626-254-1281
Practice Address - Fax:626-254-1297
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A725480Medicaid
CAA72548Medicare PIN
CAI11622Medicare UPIN