Provider Demographics
NPI:1164055851
Name:QIU, HENRY (DDS)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:QIU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 CLARINGTON AVE APT 211
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-8100
Mailing Address - Country:US
Mailing Address - Phone:420-420-2354
Mailing Address - Fax:
Practice Address - Street 1:8500 FLORENCE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4058
Practice Address - Country:US
Practice Address - Phone:562-923-4538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1046341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice