Provider Demographics
NPI:1003187766
Name:LING, JIE
Entity Type:Individual
Prefix:
First Name:JIE
Middle Name:
Last Name:LING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 HAWTHORNE WAY
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-3017
Mailing Address - Country:US
Mailing Address - Phone:650-866-0422
Mailing Address - Fax:650-651-7173
Practice Address - Street 1:101 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2605
Practice Address - Country:US
Practice Address - Phone:650-651-7175
Practice Address - Fax:650-651-7173
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine