Provider Demographics
NPI:1609352749
Name:QIAN, XU (DDS, MS, PHD)
Entity type:Individual
Prefix:
First Name:XU
Middle Name:
Last Name:QIAN
Suffix:
Gender:F
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 112TH AVE NE STE 207
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8579
Mailing Address - Country:US
Mailing Address - Phone:425-300-5558
Mailing Address - Fax:
Practice Address - Street 1:989 112TH AVE NE STE 207
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8579
Practice Address - Country:US
Practice Address - Phone:425-300-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60991059122300000X
MADF11393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADF11393OtherFACULTY LICENSE