Provider Demographics
NPI:1154610996
Name:XIONG, KI (DPM)
Entity type:Individual
Prefix:DR
First Name:KI
Middle Name:
Last Name:XIONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 OLIVE HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6115
Mailing Address - Country:US
Mailing Address - Phone:530-538-5660
Mailing Address - Fax:530-538-5661
Practice Address - Street 1:2721 OLIVE HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6115
Practice Address - Country:US
Practice Address - Phone:530-538-5660
Practice Address - Fax:530-538-5661
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5129213E00000X, 213ES0103X, 213EP1101X, 213ER0200X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine