MEDICARE: DR. XUSHENG MU D.D.S.

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	1223G0001X	General Practice Dentistry	45930	CA

General Provider Information

NPI Number	:	1700944584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XUSHENG MU D.D.S.

Provider Business Mailing Address
First Line	:	4716 CLAIREMONT MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2006
Country	:	US
Telephone Number	:	858-270-4588
Fax Number	:	858-272-8030

Provider Business Practice Location Address
First Line	:	4716 CLAIREMONT MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2006
Country	:	US
Telephone Number	:	858-270-4588
Fax Number	:	858-272-8030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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