Shaofan Kevin Xu, DDS MS

Primary specialty

DentistTaxonomy code 122300000X

License

6938 Issued in WA

Practice address

5038 Tacoma Mall Blvd
Ste. a
Tacoma, WA 98409

Phone

(253) 473-2166

Fax

(253) 473-2167

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kevin Xu Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gaurav Dudeja PLLC

  • General Practice Dentistry
  • Tacoma, WA
  • NPI 1699308619
  NPD (past)
• Kevin Xu D.D.S., M.S.,P.S., Inc.

  • General Practice Dentistry
  • Tacoma, WA
  • NPI 1578823852
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1710957329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5038 TACOMA MALL BLVD",
            "address_2": "STE. A",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98409",
            "telephone_number": "253-473-2166",
            "fax_number": "253-473-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5038 TACOMA MALL BLVD",
            "address_2": "STE. A",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98409",
            "telephone_number": "253-473-2166",
            "fax_number": "253-473-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "XU",
        "first_name": "SHAOFAN",
        "middle_name": "KEVIN",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "6938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEVIN",
            "last_name": "XU",
            "credential": "DDS MS PS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Baiyan Xie
• Alan N Xu, DC
• Min Xu, M.D.
• Qinrui Xu, FNP
• Rending Xu, MD
• Weidong Xu
• Mark Anthony Yabres, ARNP, FNP-C
• Roger K Yabu, RPH
• Alexis Yagoda, DO
• Vladimir S Yakopson, MD

• Dentist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.