Provider Demographics
NPI:1669639035
Name:HAN, TINGTING JACKIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TINGTING
Middle Name:JACKIE
Last Name:HAN
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 1:5500 TELEGRAPH RD STE 151
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4205
Mailing Address - Country:US
Mailing Address - Phone:805-256-7125
Mailing Address - Fax:
Practice Address - Street 1:5500 TELEGRAPH RD STE 151
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4205
Practice Address - Country:US
Practice Address - Phone:805-256-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice