Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE61081543 | WA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DR60951032 | WA |
NPI | 1063972594 |
---|---|
Provider Name | Dr. Xingtian Xu |
First Address | Seattle, WA 98146-2076 |
Second Address | Seattle, WA 98146-2076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2019 |
Last Update Date | 03/09/2020 |