Provider Demographics
NPI:1720149347
Name:XIONG, PHUA (MD)
Entity type:Individual
Prefix:
First Name:PHUA
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130
Mailing Address - Country:US
Mailing Address - Phone:651-209-8350
Mailing Address - Fax:
Practice Address - Street 1:1239 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130
Practice Address - Country:US
Practice Address - Phone:651-209-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN23156OtherHEALTHPARTNERS
MN489369700Medicaid
MN01-09122OtherMEDICA HEALH PLAN
MN111533OtherPATIENT CHOICE
MN120044OtherUCARE MINNESOTA
MN156J4XIOtherBLUE CROSS BLUE SHIELD
MNNA3711016033OtherPREFERREDONE
MN01-09122OtherMEDICA HEALH PLAN
MN23156OtherHEALTHPARTNERS