Provider Demographics
NPI:1508395484
Name:TENG, JIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIA
Middle Name:
Last Name:TENG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 BUENA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-2911
Mailing Address - Country:US
Mailing Address - Phone:302-494-0932
Mailing Address - Fax:
Practice Address - Street 1:3161 SENTER RD STE G&F
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1300
Practice Address - Country:US
Practice Address - Phone:408-363-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0412701223G0001X
CADDS1031201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice