Provider Demographics
NPI:1811231947
Name:JI, TINGJEN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:TINGJEN
Middle Name:
Last Name:JI
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 FARMERS LN STE 1
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4750
Mailing Address - Country:US
Mailing Address - Phone:707-539-8762
Mailing Address - Fax:
Practice Address - Street 1:170 FARMERS LN STE 1
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4750
Practice Address - Country:US
Practice Address - Phone:707-539-8762
Practice Address - Fax:707-539-2839
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice