Healthcare Provider Details

I. General information

NPI: 1316628316
Provider Name (Legal Business Name): DENTAL OFFICE OF RUIXIANG LI QIN DMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22755 FOOTHILL BLVD
HAYWARD CA
94541-4207
US

IV. Provider business mailing address

931 KENYON AVE
SAN LEANDRO CA
94577-6213
US

V. Phone/Fax

Practice location:
  • Phone: 510-782-4161
  • Fax:
Mailing address:
  • Phone: 510-688-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUIXIANG LI QIN
Title or Position: PRESIDENT
Credential: DMD
Phone: 510-688-0087