Provider Demographics
NPI:1265488340
Name:DONG, XIAOMING (MD)
Entity type:Individual
Prefix:DR
First Name:XIAOMING
Middle Name:
Last Name:DONG
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 1:4225 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4215
Mailing Address - Country:US
Mailing Address - Phone:763-588-0661
Mailing Address - Fax:763-287-2310
Practice Address - Street 1:4225 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4215
Practice Address - Country:US
Practice Address - Phone:763-588-0661
Practice Address - Fax:763-302-4345
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN471882084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00229204OtherRAILROAD MEDICARE
MN1265488340Medicaid
MN1042763OtherPREFERRED ONE
MN340G7DOOtherBCBS OF MN
MNHP48191OtherHEALTHPARTNERS
MN0500676OtherMEDICA
MN132773C029OtherUCARE
WI34602200Medicaid