Provider Demographics
NPI:1164735866
Name:DONG, JING JING (PA)
Entity Type:Individual
Prefix:MS
First Name:JING JING
Middle Name:
Last Name:DONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13336 41ST RD
Mailing Address - Street 2:UNIT 2G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3666
Mailing Address - Country:US
Mailing Address - Phone:718-864-8648
Mailing Address - Fax:718-799-1019
Practice Address - Street 1:13336 41ST RD
Practice Address - Street 2:UNIT 2G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3666
Practice Address - Country:US
Practice Address - Phone:718-864-8648
Practice Address - Fax:718-799-1019
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006466363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical