Healthcare Provider Details

I. General information

NPI: 1477470227
Provider Name (Legal Business Name): XIAO QING FUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 BROADWAY STE 350
NEW YORK NY
10003-9616
US

IV. Provider business mailing address

6972 229TH ST
OAKLAND GARDENS NY
11364-3119
US

V. Phone/Fax

Practice location:
  • Phone: 718-501-5512
  • Fax:
Mailing address:
  • Phone: 718-501-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number028978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: