Provider Demographics
NPI:1497847396
Name:ONG, JADE TING (DDS)
Entity Type:Individual
Prefix:DR
First Name:JADE
Middle Name:TING
Last Name:ONG
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 1:15243 VANOWEN ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-908-1175
Mailing Address - Fax:818-582-2556
Practice Address - Street 1:15243 VANOWEN ST
Practice Address - Street 2:SUITE 404
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-908-1175
Practice Address - Fax:818-582-2556
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist