Healthcare Provider Details

I. General information

NPI: 1457700171
Provider Name (Legal Business Name): RUOXUE FENG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8077 FLORENCE AVE STE 101
DOWNEY CA
90240-3894
US

IV. Provider business mailing address

TRIDENT GROUP 16901 MELFORD BLVD #332
BOWIE MD
20715
US

V. Phone/Fax

Practice location:
  • Phone: 562-381-2442
  • Fax: 717-848-0812
Mailing address:
  • Phone: 301-358-5461
  • Fax: 301-358-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS106156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: