Basic Information
Provider Information
NPI: 1770721367
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: XIANG
FirstName: YING
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 42210
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850802210
CountryCode: US
TelephoneNumber: 6232667770
FaxNumber: 6233224639
Practice Location
Address1: 424 S 56TH ST STE 120
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850342177
CountryCode: US
TelephoneNumber: 6026855211
FaxNumber: 6026855325
Other Information
ProviderEnumerationDate: 02/04/2009
LastUpdateDate: 08/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X43075AZY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

ID Information
IDTypeStateIssuerDescription
61956905AZ MEDICAID


Home