Basic Information
Provider Information
NPI: 1871723858
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: XIONG
FirstName: LESLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3768
Address2:  
City: MERCED
State: CA
PostalCode: 953443768
CountryCode: US
TelephoneNumber: 2097257149
FaxNumber: 2097260134
Practice Location
Address1: 535 W 25TH ST
Address2:  
City: MERCED
State: CA
PostalCode: 953402838
CountryCode: US
TelephoneNumber: 2097229066
FaxNumber: 2093831522
Other Information
ProviderEnumerationDate: 07/23/2009
LastUpdateDate: 12/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA113936CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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