Healthcare Provider Details

I. General information

NPI: 1164055851
Provider Name (Legal Business Name): HENRY QIU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 FLORENCE AVE STE 100
DOWNEY CA
90240-4058
US

IV. Provider business mailing address

3637 CLARINGTON AVE APT 211
LOS ANGELES CA
90034-8100
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-4538
  • Fax:
Mailing address:
  • Phone: 420-420-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS104634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: