Provider Demographics
NPI:1801255724
Name:XIONG, KAOSHOUA
Entity type:Individual
Prefix:
First Name:KAOSHOUA
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAO
Other - Middle Name:SHOUA
Other - Last Name:XIONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6421 SUNNYFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5782
Mailing Address - Country:US
Mailing Address - Phone:209-761-9419
Mailing Address - Fax:
Practice Address - Street 1:6421 SUNNYFIELD WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:209-761-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR11521FMedicaid