=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629405576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEI XU, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2013
-----------------------------------------------------
Last Update Date | 10/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4512 NEW FALLS RD
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19056-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-943-8820
-----------------------------------------------------
Fax | 215-943-8840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4512 NEW FALLS RD
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19056-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-943-8820
-----------------------------------------------------
Fax | 215-943-8840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LEI XU
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 267-266-8492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS036281
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------