Provider Demographics
NPI:1215491857
Name:KE, XUAN
Entity type:Individual
Prefix:
First Name:XUAN
Middle Name:
Last Name:KE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15610 BEAR VALLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8822
Mailing Address - Country:US
Mailing Address - Phone:760-245-9999
Mailing Address - Fax:760-245-8855
Practice Address - Street 1:15610 BEAR VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8822
Practice Address - Country:US
Practice Address - Phone:760-245-9999
Practice Address - Fax:760-245-8855
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2516363LF0000X
CA95011805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty