Provider Demographics
NPI:1881807022
Name:LI, XIAXIN (MD)
Entity type:Individual
Prefix:
First Name:XIAXIN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:STE 107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-412-4100
Practice Address - Fax:480-412-5154
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2018-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH350883532080P0207X
NMMD2017-00412080P0207X
AZ444162080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ606392Medicaid
AZ606392Medicaid