Provider Demographics
NPI:1497182158
Name:QIN, ZHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZHEN
Middle Name:
Last Name:QIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:QIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:365 PEARSON DR
Mailing Address - Street 2:STE 2
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3360
Mailing Address - Country:US
Mailing Address - Phone:559-788-2532
Mailing Address - Fax:
Practice Address - Street 1:365 PEARSON DR
Practice Address - Street 2:STE 2
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3360
Practice Address - Country:US
Practice Address - Phone:559-788-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA628001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice