Healthcare Provider Details

I. General information

NPI: 1508966078
Provider Name (Legal Business Name): ZHIBIN QIU, D.D.S., A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N. ATLANTIC BLVD. SUITE 246
MONTEREY PARK CA
91754-1579
US

IV. Provider business mailing address

111 N. ATLANTIC BLVD. SUITE 246
MONTEREY PARK CA
91754-1579
US

V. Phone/Fax

Practice location:
  • Phone: 626-576-1128
  • Fax: 626-576-1988
Mailing address:
  • Phone: 626-576-1128
  • Fax: 626-576-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44991
License Number StateCA

VIII. Authorized Official

Name: DR. ZHIBIN QIU
Title or Position: OWNER
Credential: D.D.S.
Phone: 626-576-1128