Provider Demographics
NPI:1316628316
Name:DENTAL OFFICE OF RUIXIANG LI QIN DMD INC.
Entity type:Organization
Organization Name:DENTAL OFFICE OF RUIXIANG LI QIN DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUIXIANG
Authorized Official - Middle Name:LI
Authorized Official - Last Name:QIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-688-0087
Mailing Address - Street 1:931 KENYON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6213
Mailing Address - Country:US
Mailing Address - Phone:510-688-0087
Mailing Address - Fax:
Practice Address - Street 1:22755 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4207
Practice Address - Country:US
Practice Address - Phone:510-782-4161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental