Basic Information
Provider Information
NPI: 1255929287
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WANG
FirstName: XUEFEI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 979 CROSS BRONX EXPY
Address2:  
City: BRONX
State: NY
PostalCode: 104604885
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 177 LIVINGSTON ST LOWR LEVEL
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112017000
CountryCode: US
TelephoneNumber: 7188557707
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/05/2021
LastUpdateDate: 01/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X  Y Dental ProvidersDental Hygienist 

No ID Information.


Home