Provider Demographics
NPI:1932783891
Name:XIAO, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:XIAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DRIVE
Mailing Address - Street 2:OTOLARYNGOLOGY - HEAD & NECK SURGERY, DC027.00
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212
Mailing Address - Country:US
Mailing Address - Phone:573-882-7935
Mailing Address - Fax:573-884-4205
Practice Address - Street 1:1 HOSPITAL DRIVE
Practice Address - Street 2:OTOLARYNGOLOGY - HEAD & NECK SURGERY, DC027.00
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212
Practice Address - Country:US
Practice Address - Phone:573-882-7935
Practice Address - Fax:573-884-4205
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200114619Medicaid