Healthcare Provider Details

I. General information

NPI: 1386664035
Provider Name (Legal Business Name): BING ELLIOT XIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 SAN BRUNO AVE W.
SAN BRUNO CA
94066-1057
US

IV. Provider business mailing address

931 SAN BRUNO AVE W.
SAN BRUNO CA
94066-1057
US

V. Phone/Fax

Practice location:
  • Phone: 415-986-2626
  • Fax: 415-986-2770
Mailing address:
  • Phone: 415-986-2626
  • Fax: 415-986-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: