Provider Demographics
NPI:1992701908
Name:XU, XUDONG (MD)
Entity type:Individual
Prefix:
First Name:XUDONG
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 BELLAIRE BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4632
Mailing Address - Country:US
Mailing Address - Phone:713-995-8886
Mailing Address - Fax:713-270-9358
Practice Address - Street 1:9160 BELLAIRE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-995-8886
Practice Address - Fax:713-270-9358
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170666501Medicaid
8M8351OtherBCBS
7311578OtherAETNA