Provider Demographics
NPI:1194230375
Name:QIN, RUIXIANG LI (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUIXIANG
Middle Name:LI
Last Name:QIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RUIXIANG
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:933 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4809
Mailing Address - Country:US
Mailing Address - Phone:510-839-1986
Mailing Address - Fax:510-839-1985
Practice Address - Street 1:933 JACKSON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4809
Practice Address - Country:US
Practice Address - Phone:510-839-1986
Practice Address - Fax:510-839-1985
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS101792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist