Provider Demographics
NPI:1396278156
Name:XIAO, ANNY (DO)
Entity type:Individual
Prefix:DR
First Name:ANNY
Middle Name:
Last Name:XIAO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 47TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2531
Mailing Address - Country:US
Mailing Address - Phone:510-684-4190
Mailing Address - Fax:
Practice Address - Street 1:25500 RANCHO NIGUEL RD STE 280
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7306
Practice Address - Country:US
Practice Address - Phone:949-448-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-09
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16682207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology