Provider Demographics
NPI:1598508798
Name:XU, JIN (DMD)
Entity type:Individual
Prefix:DR
First Name:JIN
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 VALLEY RIVER DR STE 240
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6759
Mailing Address - Country:US
Mailing Address - Phone:206-454-9891
Mailing Address - Fax:
Practice Address - Street 1:1400 VALLEY RIVER DR STE 240
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6759
Practice Address - Country:US
Practice Address - Phone:541-683-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD120101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics