Provider Demographics
NPI:1952319097
Name:XUE, HONGWEN (MD)
Entity Type:Individual
Prefix:
First Name:HONGWEN
Middle Name:
Last Name:XUE
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 1:2603 BELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7656
Mailing Address - Country:US
Mailing Address - Phone:530-758-2811
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A837790Medicaid
CA9605648OtherCIGNA
CA248463OtherINTERPLAN
CA000810659546OtherPHCS
CAMCMG337300OtherWESTERN HEALTH ADVANTAGE
CA90144700OtherPACIFICARE
CAA83779OtherBLUE CROSS
CA1850368OtherGREAT WEST
CA2372701OtherUNITED HEALTHCARE
CA5600435OtherAETNA
CA104410OtherHEALTH NET
CA5594414OtherFIRST HEALTH
CAMCMG337300OtherWESTERN HEALTH ADVANTAGE
CA5600435OtherAETNA