Provider Demographics
NPI:1164581260
Name:JIN, HANGQING (DDS)
Entity Type:Individual
Prefix:
First Name:HANGQING
Middle Name:
Last Name:JIN
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 1:9841 DEER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3432
Mailing Address - Country:US
Mailing Address - Phone:805-484-4890
Mailing Address - Fax:805-484-4890
Practice Address - Street 1:12798 RANCHO PENASQUITOS BLVD STE I
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2951
Practice Address - Country:US
Practice Address - Phone:858-353-2644
Practice Address - Fax:805-484-4890
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice