Provider Demographics
NPI:1255948741
Name:DU, ANGELA MIAOXIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MIAOXIN
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 1:741 5TH ST APT 320
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2797
Mailing Address - Country:US
Mailing Address - Phone:424-270-5289
Mailing Address - Fax:
Practice Address - Street 1:2190 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6453
Practice Address - Country:US
Practice Address - Phone:916-984-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105612122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist