Provider Demographics
NPI:1821210196
Name:DUAN, FORREST QINDE (DMD)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:QINDE
Last Name:DUAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:FORREST
Other - Middle Name:Q
Other - Last Name:DUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2340 JUDAH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1539
Mailing Address - Country:US
Mailing Address - Phone:415-665-8404
Mailing Address - Fax:415-665-8683
Practice Address - Street 1:2340 JUDAH ST.
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1539
Practice Address - Country:US
Practice Address - Phone:415-665-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385181223P0700X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0700XDental ProvidersDentistProsthodontics