Provider Demographics
NPI:1518308105
Name:JING, WILSON SHUAIWEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:SHUAIWEN
Last Name:JING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 DURHAM RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4862
Mailing Address - Country:US
Mailing Address - Phone:601-750-0543
Mailing Address - Fax:
Practice Address - Street 1:43000 MIDWAY DR MARINE CORP RECRUITING STATION BLDG 595
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-4500
Practice Address - Country:US
Practice Address - Phone:619-524-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA629501223S0112X, 122300000X
NC109831223S0112X
MSM12345678390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program