Provider Demographics
NPI:1164434072
Name:CHING, STEPHEN WAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WAI
Last Name:CHING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4809
Mailing Address - Country:US
Mailing Address - Phone:510-763-1999
Mailing Address - Fax:
Practice Address - Street 1:933 JACKSON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4809
Practice Address - Country:US
Practice Address - Phone:510-763-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46464-01OtherMEDIAL DENTAL PROGRAM