Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10112024 | OR |
NPI | 1164608626 |
---|---|
Provider Name | Ji Xu |
First Address | Vancouver, WA 98684-6053 |
Second Address | Vancouver, WA 98684-6053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 15/01/2008 |