Provider Demographics
NPI:1346672649
Name:FANG, JING (DDS)
Entity Type:Individual
Prefix:DR
First Name:JING
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JING
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:12762 ANNETTE CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840
Mailing Address - Country:US
Mailing Address - Phone:714-308-9795
Mailing Address - Fax:714-621-0096
Practice Address - Street 1:12762 ANNETTE CIR
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-6103
Practice Address - Country:US
Practice Address - Phone:714-308-9795
Practice Address - Fax:714-621-0096
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist