Provider Demographics
NPI:1316419211
Name:KANG, XIAOXU (RN)
Entity type:Individual
Prefix:MS
First Name:XIAOXU
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16422 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3202
Mailing Address - Country:US
Mailing Address - Phone:646-920-3222
Mailing Address - Fax:
Practice Address - Street 1:13626 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6533
Practice Address - Country:US
Practice Address - Phone:718-886-1212
Practice Address - Fax:718-886-2568
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY758169163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse