Provider Demographics
NPI:1821247107
Name:LI, QIN (DMD)
Entity Type:Individual
Prefix:
First Name:QIN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 CATAMARAN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3135
Mailing Address - Country:US
Mailing Address - Phone:650-283-7550
Mailing Address - Fax:
Practice Address - Street 1:8201 EDGEWATER DR
Practice Address - Street 2:STE 105 AND 106
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2016
Practice Address - Country:US
Practice Address - Phone:510-568-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist