Organization
KEVIN XU D.D.S., M.S.,P.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN XU DDS (DENTIST/OWNER)
(253) 473-2166
Entity
Organization
Contact information
Practice address
5038 TACOMA MALL BLVD, STE. A, TACOMA, WA 98409-7103
(253) 473-2166
(253) 473-2167
Mailing address
5038 TACOMA MALL BLVD, STE. A, TACOMA, WA 98409-7103
(253) 473-2166
(253) 473-2167
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6938
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710957329
INDIVIDUAL
WA
01
—
1821074527
INDIVIDUAL
WA
Enumeration date
05/21/2012
Last updated
05/21/2012
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