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General NPI Number Information
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NPI Number | 1578823852
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Entity Type | Organization
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Legal Business Name | KEVIN XU D.D.S., M.S.,P.S., INC.
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 5038 TACOMA MALL BLVD STE. A
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City | TACOMA
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State | WA
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Zip | 98409-7103
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Country | US
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Telephone | 253-473-2166
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Fax | 253-473-2167
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Provider Business Mailing Address
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Address Line | 5038 TACOMA MALL BLVD STE. A
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City | TACOMA
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State | WA
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Zip | 98409-7103
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Country | US
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Telephone | 253-473-2166
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Fax | 253-473-2167
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. KEVIN XU
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Credential | DDS
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Telephone | 253-473-2166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6938
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License Number State | WA
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