MEDICARE: WANYUN XUE DENTAL P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	054410-1	OTHER	NY	DENTAL LICENSE

General Provider Information

NPI Number	:	1366092850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANYUN XUE DENTAL P.C.

Provider Business Mailing Address
First Line	:	93 RAPELYE ST APT 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-2629
Country	:	US
Telephone Number	:	718-852-3793
Fax Number	:

Provider Business Practice Location Address
First Line	:	396 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4206
Country	:	US
Telephone Number	:	718-852-3793
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WANYUN XUE
Credential	:	DDS
Telephone Number	:	718-852-3793

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	12/06/2022

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