Provider Demographics
NPI:1154970606
Name:THRASH, XUEJIAO
Entity type:Individual
Prefix:
First Name:XUEJIAO
Middle Name:
Last Name:THRASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 MACAULAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1944
Mailing Address - Country:US
Mailing Address - Phone:214-384-9530
Mailing Address - Fax:
Practice Address - Street 1:3380 STURTEVANT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5041
Practice Address - Country:US
Practice Address - Phone:619-708-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist