Healthcare Provider Details

I. General information

NPI: 1639486541
Provider Name (Legal Business Name): HAI QING DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 GREENWOOD AVE STE 10
JENKINTOWN PA
19046-2900
US

IV. Provider business mailing address

1564 DERRY DR
DRESHER PA
19025-1212
US

V. Phone/Fax

Practice location:
  • Phone: 267-217-3218
  • Fax:
Mailing address:
  • Phone: 585-201-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS041063
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: