Provider Demographics
NPI:1629860655
Name:XIONG, KA YOUA (LDO, ABOC, NCLEC)
Entity type:Individual
Prefix:
First Name:KA YOUA
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:LDO, ABOC, NCLEC
Other - Prefix:MISS
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:XIONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LDO, ABOC, NCLEC
Mailing Address - Street 1:3540 E FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-6297
Mailing Address - Country:US
Mailing Address - Phone:704-866-7351
Mailing Address - Fax:704-866-9385
Practice Address - Street 1:3540 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-6297
Practice Address - Country:US
Practice Address - Phone:704-866-7351
Practice Address - Fax:704-866-9385
Is Sole Proprietor?:No
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2310156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician