Provider Demographics
NPI:1225240567
Name:QIU, ZHIBIN
Entity Type:Individual
Prefix:
First Name:ZHIBIN
Middle Name:
Last Name:QIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N ATLANTIC BLVD
Mailing Address - Street 2:SUITE 246
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1582
Mailing Address - Country:US
Mailing Address - Phone:626-576-1128
Mailing Address - Fax:
Practice Address - Street 1:111 N ATLANTIC BLVD
Practice Address - Street 2:SUITE 246
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1582
Practice Address - Country:US
Practice Address - Phone:626-576-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice