Provider Demographics
NPI:1669712089
Name:XIONG, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 E HERNDON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2989
Mailing Address - Country:US
Mailing Address - Phone:559-228-6600
Mailing Address - Fax:559-226-3709
Practice Address - Street 1:568 E HERNDON AVE STE 201
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2989
Practice Address - Country:US
Practice Address - Phone:559-228-6600
Practice Address - Fax:559-226-3709
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018688363LF0000X, 363LP2300X
CA9501688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10AQMedicaid