Provider Demographics
NPI:1558753764
Name:SIU, JENNIFER RUIZHE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUIZHE
Last Name:SIU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:RUIZHE
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:955 POWELL AVE SW
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2908
Mailing Address - Country:US
Mailing Address - Phone:425-277-1311
Mailing Address - Fax:252-771-5664
Practice Address - Street 1:16345 NE 87TH ST # C2
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3503
Practice Address - Country:US
Practice Address - Phone:425-883-8000
Practice Address - Fax:425-883-7580
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60669867122300000X
WARR60558503390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist