Provider Demographics
NPI:1417684598
Name:YI, JINGZHENG (DDS)
Entity Type:Individual
Prefix:
First Name:JINGZHENG
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 E ALLUVIAL AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0479
Mailing Address - Country:US
Mailing Address - Phone:858-888-6340
Mailing Address - Fax:
Practice Address - Street 1:3920 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5270
Practice Address - Country:US
Practice Address - Phone:559-412-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14793122300000X
CA108734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist