Basic Information
| Provider Information | |||||||||
| NPI: | 1265488340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONG | ||||||||
| FirstName: | XIAOMING | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 GOLDEN VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | GOLDEN VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554224215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635880661 | ||||||||
| FaxNumber: | 7632872310 | ||||||||
| Practice Location | |||||||||
| Address1: | 4225 GOLDEN VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | GOLDEN VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554224215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635880661 | ||||||||
| FaxNumber: | 7633024345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0600X | 47188 | MN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 2084N0400X | 47188 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | P00229204 | 01 | MN | RAILROAD MEDICARE | OTHER | 1265488340 | 05 | MN | MEDICAID | 1042763 | 01 | MN | PREFERRED ONE | OTHER | 340G7DO | 01 | MN | BCBS OF MN | OTHER | HP48191 | 01 | MN | HEALTHPARTNERS | OTHER | 0500676 | 01 | MN | MEDICA | OTHER | 132773C029 | 01 | MN | UCARE | OTHER | 34602200 | 05 | WI | MEDICAID |