Provider Demographics
NPI:1750819959
Name:DU, XUE (DDS)
Entity Type:Individual
Prefix:
First Name:XUE
Middle Name:
Last Name:DU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15613 BEL RED RD STE C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2348
Mailing Address - Country:US
Mailing Address - Phone:425-869-7560
Mailing Address - Fax:425-869-7699
Practice Address - Street 1:15613 BEL RED RD STE C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2348
Practice Address - Country:US
Practice Address - Phone:425-869-7560
Practice Address - Fax:425-869-7699
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2020-04-29
Deactivation Date:2018-01-05
Deactivation Code:
Reactivation Date:2018-01-11
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA607535321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program